Role of VisanteTM Anterior Segment OCT as an Adjunctive Tool in the Management of a Case With Successfully Reconstructed Ocular Surface for Unilateral Limbal Stem Cell Deficiency and Dense Corneal Scar

Abstract

Purpose:: To report the value of Visante^TM Anterior Segment OCT as a tool for the diagnosis and further treatment of dense corneal scarring with total limbal stem cell deficiency secondary to alkali burns

Methods:: We report a 26 years-old Hispanic female with dense corneal scarring and symblepharon formation due to severe alkali burns in the right eye. She underwent initially ocular surface reconstruction that included symblepharon lysis, corneal pannus excision, intraoperative 0.02% mitomycin- C, autologous limbal stem cell transplantation and amniotic membrane transplantation; followed 3 months later by corneal transplantation with amniotic membrace graft (PROKERA^TM, Bio-tissue, Miami US ). For the limbal stem cell deficiency, we used clinical criteria along with the visualization of corneal pannus by using Visante^TM Anterior Segment OCT preoperatively and after corneal transplantation for detecting corneal pannus recurrence.

Results:: Mean follow-up time was 4 months. The pre-operative VA was light perception with projection and slit lamp examination showed a dense corneal scar with 360 degree conjunctivalization and fleshy superior symblepharon. The preoperative OCT showed a well demarcated peripheral corneal pannus with a mean thickness of 319.7±95.8 µm and peripheral residual corneal stromal thickness of 760±35.8 µm. The central pannus thickness was 134µm and central residual corneal stroma thickness was 759 µm. After 3 months of the initial procedure, VA improved to HM, slit lamp examination showed deep, quiet fornix with dense residual corneal scar with minimal vascularization. One month following corneal transplantation, VA improved to 20/100 and the graft was clear with intact epithelium. OCT showed peripheral graft thickness of 750µm and central central corneal thickness of 521µm with no evidence of pannus recurrence.

Conclusions:: Interestingly, this case revealed that the pannus tends to be thicker in the periphery and thinner centrally and showed that anterior segment OCT is a valuable tool in the diagnosis, surgical planning and further follow up of corneal pannus recurrences on the corneal graft in eyes with total limbal stem cell deficiency.

Keywords: cornea: epithelium • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • transplantation