Conjunctival Autograft Can Restore Corneal Epithelium in Partial Limbal Stem Cell Deficiency

In eyes with unilateral partial limbal stem cell deficiency (LSCD), conjunctival autograft (CAG) is a safe and effective treatment modality for restoring corneal epithelium, according to a case series published in Clinical Ophthalmology. According to the comparative study, CAG may be the best method available for treating partial LSCD.   

Researchers from the L.V. Prasad Eye Institute, in India, examined 30 eyes of 30 patients with unilateral partial LSCD. After corneal pannus dissection, 17 patients underwent CAG and 13 patients underwent simple limbal epithelial transplant (SLET). The primary outcome in both groups was anatomical success. The study defined anatomical success as completely epithelialized, stable, and avascular corneal surface at the final postoperative visit. 

The team determined that both groups were comparable with regards to age at time of surgery, preoperative best-corrected visual acuity (BCVA), median duration since injury, number of clock hours of limbus involved, and history of prior surgeries. They also noted that more men underwent CAG than SLET (P =.049). In both groups, the most frequent etiologies for LSCD were chemical burns.  

At a median follow-up of 5.6 months [interquartile range (IQR): 3.6–15.1], 88% of eyes (15/17) that underwent CAG maintained a completely epithelialized, stable, and avascular corneal surface. At a median follow-up of 6.2 months (IQR: 4.5–12.2), 38% of eyes (5/13) that underwent SLET showed anatomical success. 

The anatomical success rates were 86.5±8.9% in the CAG group and 28.3±13.7% in the SLET group at the last follow-up visit (P =.025), the investigators report. They reported no intraoperative complications in either group during CAG harvest or during limbal biopsy. The majority of failures in both groups transpired within the first 8 months after surgery.

Limitations of the case series include the retrospective nature, small number of eyes, and relatively short follow-up. 

CAG may be a better alternative than limbal stem cell transplantation (LSCT) and amniotic membrane transplantation (AMT) for treatment of unilateral partial LSCD, the report suggests. 

“LSCT or AMT in these eyes may not be necessary,” according to the report. “Hence, the treatment of unilateral partial LSCD may become accessible to developing countries and patients who might not be able to afford other treatment options.”

Reference

Shanbhag SS, Chanda S, Donthineni PR, Basu S. Surgical management of unilateral partial limbal stem cell deficiency: conjunctival autografts versus simple limbal epithelial transplantation.Clin Ophthalmol. Published online November 9, 2021. doi:10.2147/OPTH.S338894