Childhood bilateral limbal stem cell deficiency: long-term management and outcome

A 6-year-old boy presented in 1998 with a 1 month history of lime injury in both eyes. Grade 4 chemical injury (Roper-Hall classification) progressed to total limbal stem cell deficiency in both eyes. Between July 2000 and July 2009, he cumulatively underwent 11 limbal stem cell transplantation surgeries, either direct or cultivated from either his father or mother, and 3 corneal transplants in both eyes. Each of the procedures led to a transient clearing of his visual axis to give vision in the range of 20/60 to 20/100 for a period of 1-3 months after which it failed. He finally underwent Boston keratoprosthesis implantation and now enjoys 20/20 vision with stable optic disc and visual field at a follow-up of 41 months. Timely intervention in childhood helped in prevention of amblyopia in this patient. Perseverance by the patient, his relatives and treating ophthalmologist is very important.