A CASE OF LIMBAL STEM CELL DEFICIENCY SECONDARY TO VARIANT ANIRIDIA TREATED BY KERATOLIMBAL ALLOGRAFT

Title A CASE OF LIMBAL STEM CELL DEFICIENCY SECONDARY TO VARIANT ANIRIDIA TREATED BY KERATOLIMBAL ALLOGRAFT
Author, Co-Author Jessica Jarvis
Topic
Year
2013
Day
Program Number
R02013078
Room
Room 6C
Affiliation
Abstract BACKGROUND: A patient is referred for limbal stem cell deficiency and severe ocular surface disease, ultimately discovered to be secondary to variant aniridia. After months of unresponsiveness to medical treatment, a keratolimbal allograft is performed.

CASE REPORT(S): Chief complaint A 38-year-old female was referred for corneal consult for limbal stem cell deficiency (LSCD) of unknown cause. She complains of burning, sharp pain, foreign body sensation, and decreased vision OD>OS. Ocular, medical history Strabismus surgery OD Superficial keratectomy OD Hypothyroidism Medications Doxycycline Restasis Protopic Pertinent findings DVA: 20/40 OD 20/30 OS Schirmer: >30 mm OU Lids and lashes: 3+ meibomian gland deficiency (MGD) OU Cornea: 360? pannus with late fluorescein staining OU, subepithelial fibrosis OU, pseudopterygium OS>OD, Salzmann’s reaction OS Conjunctiva: mild injection OU Diagnosis LSCD secondary to variant aniridia Differentials Severe ocular surface disease Aniridic keratopathy MGD Salzmann’s LSCD Symptoms Decreased vision Irritation Photophobia Pain Signs Epithelial defects Pannus Conjunctivalization Loss of palisades of Vogt Late staining Common causes Aniridia Chemical or thermal injuries Autoimmune disease Iatrogenic Treatment Options Keratolimbal Allograft (KLAL) Conjunctival Limbal Autograft (CLAU) Living Related Conjunctival Limbal Allograft (lr-CLAL) Treatment The patient underwent a KLAL, a transplantation of cadaveric limbal tissue attached to a corneal carrier. Symptoms have improved significantly as she continues to be managed post-operatively.

CONCLUSIONS: Limbal stem cells are responsible for the self-renewing process of corneal epithelial cells, which is important in maintaining corneal structure and function. Because the ocular surface is not capable of returning to normal without adequate limbal stem cells, diagnosis and management of patients with significant LSCD is crucial. Surgical treatment consists of transplantation of normal stem cells using cadaveric or living tissue.
Affiliation of Co-Authors
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