Long-term outcome of allogeneic cultivated limbal epithelial transplantation for symblepharon caused by severe ocular burns

Abstract

Background: The therapeutic effects of allogeneic cultivated limbal epithelial transplantation (CLET) for symblephara at different degrees caused by ocular burns were evaluated in this study.

Methods: A series of interventional cases were involved in this retrospective study. Eighty eyes (80 patients) with symblephara underwent CLET and the success rates of surgical treatment as well as corneal conditions and risk factors for recurrent symblepharon were analyzed.

Results: The average age of patients was 32.4 ± 13.7 years (ranged from 4 to 60 years). The average follow-up time was 26.4 ± 13.6 months (ranged from 12 to 60 months). Symblepharon cases were caused by chemical burns (36 eyes) or thermal burns (44 eyes). The first surgical intervention achieved complete success in 40 eyes (50%), partial success in 25 eyes (31.3%), and failure in 15 eyes (18.8%). The rate of complete success was 85.0% in eyes with grade I/II symblephara, 51.5% in eyes with grade III eyes and 22.2% in eyes grade IV symblephara (P = 0.001). The treatment was completely successful in 23.1% of eyes with moderate or severe preoperative inflammatory action and 63.0% of eyes with mild or no inflammation (P = 0.000). The corneal conditions were improved in 43 eyes (53.8%), of which 21 eyes had improved visual acuity. The recurrence of symblepharon after the first CLET was positively correlated with symblepharon length (P = 0.003), preoperative inflammatory activity (P = 0.016) as well as postoperative cicatricial entropion and trichiasis (P = 0.038).

Conclusions: CLET was effective on the recovery of anatomically deep fornixes in eyes caused by symblephara and corneal surface condition could be improved simultaneously. The success of surgical treatment was dependent on the effective control of inflammation and timely management of eyelid abnormalities.

Keywords: Chemical burn; Cultivated limbal epithelial transplantation; Symblepharon; Thermal burn.

Fig. 1

Grade IVb 0 symblepharon in the inferionasal fornix resulting from thermal burn (a); during the follow-up of 4.5 years, a deep fornix with complete success and a non-neovascularized cornea was noted (b). Grade IIIb 1+ symblepharon in the inferionasal and superonasal fornices resulting from thermal burn (c); a deep fornix without inflammation was noted together with a non-neovascularized cornea during 2 years of follow-up (d). Grade IIIb 1+ symblepharon in the superior fornix resulting from chemical burn (e); a deep fornix with complete success and a clear cornea was noted during 18 months of follow-up (f)

Fig. 2

Grade IVa 1+ symblepharon in the inferior fornix resulting from thermal burn (a). a deep fornix was achieved 2 years later (b), and the appearance was improved through wearing a cosmetic contact lens (c)

Fig. 3

Survival analysis showing the clinical outcome of cultivated limbal epithelial transplantation for eyes with thermal burns and chemical burns

Fig. 4

Survival analysis showing the clinical outcome of cultivated limbal epithelial transplantation for different grades of symblepharon