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Limbal stem cell transplantation for soft contact lens wear-related limbal stem cell deficiency.

Am J Ophthalmol. 2015 Aug 20;

Authors: Shen C, Chan CC, Holland EJ

Abstract
PURPOSE: To describe the outcomes of limbal stem cell transplantation in eyes with limbal stem cell deficiency related to soft contact lens wear.
DESIGN: Retrospective interventional case series METHODS: Institutional database search at the Cincinnati Eye Institute revealed 9 patients (14 eyes) who underwent limbal stem cell transplantation with systemic immunosuppression for soft contact lens wear-related limbal stem cell deficiency. Outcome measures included patient demographics, symptoms, best corrected visual acuity, ocular surface stability, adverse events, and additional surgeries required.
RESULTS: Average patient age at time of surgery was 46.6 ± 11.1 years (range 20 to 60 years). Average duration of follow-up was 28 ± 19.1 months (range 12 to 70 months). Preoperative best corrected visual acuity (BCVA) was 20/40 or worse in all eyes (average 20/70, range 20/40 to 20/250) and patient symptoms included foreign body sensation, tearing, redness and/or pain. Four eyes (29%) underwent living-related conjunctival limbal allograft and 10 eyes (71%) underwent cadaver-donor keratolimbal allograft surgery. Topical and systemic immunosuppression was used in all patients. At final follow-up after limbal stem cell transplantation, there was a stable ocular surface in 12/14 (86%) eyes, and improvement in BCVA to 20/30 or better and complete resolution of patient symptoms in all except 1 patient who had significant rosacea blepharokerato-conjunctivitis whose BCVA remained at 20/150 and 20/60, in right and left eyes, respectively. The most common adverse event was an increase in intraocular pressure in 8 of 14 (57%) eyes, requiring topical anti-glaucoma treatment. Ten of 14 (71%) eyes underwent cataract extraction related to topical steroid use. No eyes required subsequent penetrating keratoplasty.
CONCLUSION: Limbal stem cell transplantation is a viable option for the management of soft contact lens wear-related limbal stem cell deficiency in young healthy patients. Early intervention prior to subepithelial fibrosis can lead to good visual outcomes with no need for subsequent cornea transplant. Co-management with a solid organ transplant specialist is helpful for the monitoring and management of systemic adverse events related to patient systemic immunosuppression.

PMID: 26299533 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/26299533?dopt=Abstract = URL to article

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