Long-term Outcome of Limbal Stem Cell Transplantation for the Management of Total Limbal Stem Cell Deficiency due to a Chemical Burn

Purpose: To evaluate the long-term outcome of limbal stem cell transplantation (LSCT) for the management of total limbal stem cell deficiency (LSCD) due to chemical burn in Labbafinejad Medical Center (LMC). Methods: Records of patients with a history of severe (i.e. grade III and IV) chemical burns, who were referred to LMC and underwent LSCT, were reviewed and data including demographic characteristics, initial visual acuity, surgical interventions, and outcomes were extracted. Results: A total of 50 eyes of 50 patients with a history of conjunctival limbal autograft (CLAU; N=24) or keratolimbal allograft (KLAL; N=26) with at least 1-year follow-up were included. Mean age, initial visual acuity, and follow-up duration were not significantly different between the two groups. The overall 1-year and 5-year survival was 100% and 78.1% for CLAU and 84.4% and 53.6% for KLAL, respectively. Corneal transplantation was performed after LSCT in 20 eyes after CLAU and 25 eyes after KLAL. The 1-year and 5-year corneal graft survival was 93.3% and 63.8% after CLAU and 92% and 38.4% after KLAL, respectively. Simultaneous KLAL and corneal transplantation were performed in 5-eyes. The 5-year survival of the KLAL and the corneal graft after the simultaneous procedure was 37.5% and 0. There was a significant improvement in LogMAR BCVA (1.79 vs. 2.17, P<0.001) in both groups, but it was not significantly different between the two-group. Conclusion: Severe chemical burn is associated with significant ocular morbidity and long-term prognosis is guarded. Simultaneous LSCT and corneal grafting may decrease the long-term survival of both.