This retrospective study found that autologous cultivated limbal epithelial transplantation (CLET) was successful in restoring the ocular surface and improving vision in only around half of the children blinded by ocular burns who underwent this treatment at one eye institute in India.
This is believed to be the first report of outcomes for this procedure in children.
The study included 107 children with limbal stem cell deficiency (LSCD) secondary to chemical or thermal injury who were followed for at least one year after undergoing unilateral autologous CLET by a simple, xeno-free, explant culture technique over a 10-year period. Unintentional injury with calcium hydroxide was the most common cause of LSCD among these patients.
At a mean follow-up of 3.4 years, 50 eyes (46.7 percent) achieved completely epithelialized, avascular and stable ocular surfaces. At the final visit, 58 eyes (54.2 percent) had improvement in visual acuity of 0.2 logMAR or greater.
The success rate in this study is lower than that of other studies, highlighting the poorer outcomes in children, despite similar causes of LSCD.
The authors note that use of the Boston keratoprosthesis is being considered for unilateral LSCD, but the need for long-term use of a bandage contact lens and topical antibiotics to prevent tissue necrosis and secondary infection makes its use less appealing in developing countries because of the lack of hygiene and low adherence to antibiotic use.
They conclude that management of LSCD in children remains challenging, with poorer outcomes than in adults and amblyopia limiting the visual outcome. They say that timely intervention in pediatric patients to achieve ocular surface stability, followed by visual rehabilitation and amblyopia management, is essential to maximize outcomes.