A Case of Autologous Cultivated Limbal Stem Cell Transplantation

The patient presented herein, is a 29-yearold man with history of unilateral alkaline chemical injury 14 years ago. Upon referral, visual acuity was 20/20 and the examination was unremarkable in the right eye. Vision was hand motions (HM) in his left eye and a small angle exotropia (10-15 Prism Diopters) was evident. Slitlamp examination revealed severe corneal opacification and vascularization (Fig. 1). Intraocular pressure (IOP) was 13 and 10 mmHg in the right and left eyes, respectively. B-scan ultrasonography ruled out gross posterior segment pathologies and impression cytology revealed total limbal stem cell deficiency (LSCD) in the left eye. The injured eye underwent cultivated autologous stem cell transplantation on amniotic membrane (AM) after punctal cauterization. The patient received a topical steroid (betamethasone 0.1%, Sina-Daru, Tehran, Iran), and an antibiotic (chloramphenicol 0.5%, Sina-Daru, Tehran, Iran). Antibiotic drops were continued for 1 to 2 weeks until complete epithelialization. Steroid drops were tapered off according to the level of ocular inflammation over 6-8 weeks. A preservativefree artificial tear (Artelac, Bausch and Lomb, USA) was used for lubrication as needed. The patient received systemic prednisolone 1 mg/ kg (Sina-Daru, Tehran, Iran) for 3 to 4 weeks. Visual acuity in the left eye improved to counting fingers at 75 cm along with modest decrease in corneal vascularization and opacity 3 months after the procedure (Fig. 2). Due to deep corneal stromal opacification, penetrating keratoplasty (PKP) was performed 6 months later. One month after PKP, visual acuity improved to 20/120. The patient complained of diplopia which was due to improvement in vision and the small angle exotropia. Six weeks later, IOP increased to 32 mmHg which was controlled by topical timolol 0.5% (Sina-Daru, Tehran, Iran) two times per day and systemic acetazolamide 250mg, three times per day. Cup-disc ratio was 0.3. Systemic acetazolamide was discontinued due to elevated liver enzymes and replaced by topical dorzolamide 2% (Sina-