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Decade-Long Follow-Up of Autologous Simple Limbal Epithelial Transplantation in Pediatric Patients With Unilateral
Amanjot Kaur1, Neha Jain2, Vikas Mittal2
1Cornea and Anterior Segment Services, L J Eye Institute, Patiala, Punjab, India ; and.
Purpose:
This study evaluates the decades-long visual and functional outcomes of autologous simple limbal epithelial transplantation (SLET) in pediatric patients with unilateral limbal stem cell deficiency (LSCD). It also observes the challenges faced while managing the ocular burns in such patients.
Methods:
A retrospective review was conducted on pediatric patients (<15 years) who underwent unilateral SLET for LSCD and had a minimum follow-up of 10 years. The study analyzed demographic data, clinical history, slit-lamp biomicroscopic findings, age at the time of SLET, surgical outcomes, postoperative complications, and visual outcomes after a decade of follow-up. The functional outcome was categorized as complete success if the ocular surface remained stable and avascular.
Results:
Three pediatric patients with unilateral ocular injuries (grade 6 ocular burns, as per Dua's Classification) caused by lime exposure in 2 cases and a firecracker injury in 1 case were evaluated. These injuries led to complete LSCD and symblepharon formation. All patients initially underwent primary amniotic membrane grafting to promote healing of the epithelial defect. The mean age at the time of SLET was 4 years, with a mean interval of 4 months between the initial injury and SLET. One patient underwent penetrating keratoplasty to address a dense central scar for vision rehabilitation. The donor eyes remained unaffected, and all patients experienced significant visual improvement (visual acuity improving from 1.8 to 0.67 LogMAR). The ocular surface remained stable even after a decade of follow-up.
Conclusions:
Pediatric ocular burns leading to LSCD are difficult to manage. Autologous SLET with conjunctival autografting is a durable treatment for unilateral chemical injuries in such cases. It offers significant long-term visual and cosmetic improvement while ensuring a stable ocular surface. However, simultaneous amblyopia therapy is necessary, which makes visual recovery challenging.
