LİMBAL KÖK HÜCEYRƏ TRANSPLANTASİYASI İLƏ KİMYƏVİ YANIQLARDAN SONRAKI BİRTƏRƏFLİ TOTAL LİMBAL KÖK HÜCEYRƏ DEFISİTİNİN MÜALİCƏSİ (KLİNİKİ HAL)

Xülasə

SUMMARY

Damage to the stem cells may lead to Limbal Stem Cell Defciency (LSCD). In the absence of a healthy corneal epithelium, the conjunctiva proliferates over the cornea resulting in opacifcation and vascularization, which in turn may lead to reduced vision, pain, and photophobia. LSCD can be caused by a wide variety of primary and secondary causes but is most frequently seen associated with severe chemical or thermal burns.
Therapeutic options for LSCD range from conservative to invasive and depend on the severity of the pathology.
If there are no remaining stem cell reserves, the cornea must be reseeded with new LESCs. The earliest techniques required large sections of donor tissue either from the patient’s fellow eye (autograft) or from a healthy donor or cadaver (allograft). Taking such large biopsies places the donor eye at risk of developing LSCD.
In 2012 simple limbal epithelial transplantation (SLET) was described as a novel surgical technique for the treatment of unilateral LSCD.
The patient which we would like to introduce, 42 y/o, male patient had chemical injury in right eye (Phosphoric acid), with complication of decrease of vision and pain on eyes, entered to “Swarup Eye Centre” (Hyderabad, India). VisOD=0.1, VisOS=0.3 k/i+1.0/-2.75/10˚ 0.7; TnOD=N (Palpator), TnOS=11 mmHg IV Grade Total Chemical Injury, Total Limbal Stem Cell Defciency.
In right eye performed resection of necrotic tissues and Human Amniotic Membrane Transplantation.
After one month the imfammation of ocular surface reduced, but there was total epitelial defects, ischemic area of screla, Limbal Stem cell defciency, sterile hypopion on anterior chamber and periphery corneal melting.
To prevent corneal perforation and increase lubrication there was performed Tenonoplasty+Midperipheral Tarsorraphy. During surgery took stab from anterior chamber and sent to laboratory. Report was negative.
After 4 months eye was quite, the ischemic area vascularized, corneal melting stopped and sterile imfammatory process stopped.
Total LSCD, thick fbrovascular tissue, superfcially vascularization and conjunctivalization have seen. Dryness, symblefaron and trichiasis on ocular surface were excluded.
Performed, Tarsorraphy reliese+SLET surgery on right eye. During surgery there appeared that there are stromal scar and cataract.
Postoperative after 1st, 5, 14 days the patient was checked.
Postoperatively 14 days there was epithelialiaation on Amniotic membrane. Intrastromal scarring and cataract. The patient is under supervision and will be checked up every month till full stabilisation of ocular surface.
The future plan after corneal and ocular surface stabilisation we can perform DALK(or PK) or catacact extraction with implantation Toric IOL.
Over the past few years, great advances in LESC identifcation and characterization and ocular surface reconstruction have been made. With the introduction of SLET, a safe and successful treatment option for LSCD has been introduced.