One Block Conjunctival Limbal Autograft for Unilateral Total Limbal Stem Cell Deficiency

To evaluate the results of one 60-degree block conjunctival limbal autograft (CLAU) surgery in patients with unilateral total limbal stem cell deficiency (LSCD). Five eyes of 5 patients were included. All patients had a history of chronic total unilateral LSCD due to a chemical injury. Two patients underwent one 60-degree block CLAU with amniotic membrane transplantation, two patients had been complicated by inadvertent trephination of one block of a previous successful two-block CLAU at the time of subsequent corneal transplantation, and the last patient had been complicated by one CLAU segment loss due to loose sutures and premature suture removal. The main outcome of the study was corneal epithelial healing. All patients developed persistent epithelial defect unresponsive to the conservative medical management. To restore epithelial integrity in cases with one-block CLAU, classic two-block CLAU was performed later. In two cases with inadvertent one segment trephination, corneal perforation occurred despite both conservative and surgical management. Tectonic keratoplasty was performed in these two eyes. These grafts developed persistent epithelial defect, which was covered with large sectoral vascularized corneal pannus in one eye and with mucous membrane grafting in the other eye. In the last patient with lost lenticule, cultivated limbal epithelial transplantation was performed to treat the epithelial defect. One-block (60-degree segment) limbal transplantation during conjunctival limbal autograft surgery is not sufficient for anatomical and visual rehabilitation of an eye with total unilateral LSCD.