Primary limbal stem cell transplantation in the surgical management of extensive ocular surface squamous neoplasia involving the limbus

• Published in: Indian journal of ophthalmology Vol. 66; no. 11; pp. 1569 - 1573
• Main Authors: Narang, Purvasha, Mittal, Vikas, Menon, Vikas, Bhaduri, Anirban, Chaudhuri, Bhaskar, Honavar, Santosh
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.11.2018; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Adult; Aged; Aged, 80 and over; Alcohol; Allografts; Amniotic membrane; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Care and treatment; Chemotherapy; Conjunctiva - cytology; Conjunctiva - transplantation; Conjunctival limbal autograft; Corneal Transplantation - methods; Cryotherapy; Excision (Surgery); Eye diseases; Eye Neoplasms - pathology; Eye Neoplasms - surgery; Female; Follow-Up Studies; Humans; limbal stem cell deficiency; limbal stem cell transplantation; Limbus Corneae - cytology; Limbus Corneae - surgery; Male; Metastases; Metastasis; Middle Aged; Morbidity; ocular surface squamous neoplasia; Ophthalmology; Original; Patients; Retrospective Studies; simple limbal epithelial transplantation; Squamous cell carcinoma; Stem cell transplantation; Stem Cell Transplantation - methods; Stem cells; Surgery; Surgical techniques; Time Factors; Transplants & implants; Treatment Outcome; Tumors; simple limbal epithelial transplantation; Conjunctival limbal autograft; limbal stem cell deficiency; limbal stem cell transplantation; ocular surface squamous neoplasia
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_348_18

Purpose: To determine the role of primary limbal stem cell transplantation (LSCT) in managing extensive ocular surface squamous neoplasia (OSSN) with more than 3 quadrants of limbal involvement to prevent manifestations of limbal stem cell deficiency. Methods: A multi-center, comparative, and interventional clinical study of cases and historical controls was done. Patients with a limbal mass suggestive of OSSN involving more than 3 quadrants of limbus (> 9 clock hours) and no local, regional or systemic metastasis, who underwent primary surgical excision with or without adjuvant chemotherapy and had a minimum follow-up of 12 months were included in this study. Two historical controls underwent tumor excision with only amniotic membrane grafting. Three cases underwent tumor excision along with LSCT in the form of conjunctival limbal autograft (CLAG) or simple limbal epithelial transplant (SLET). Results: None of the eyes had any recurrences of OSSN during the follow-up period. Cases with primary LSCT with tumor excision showed better ocular surface stability in the long term. Conclusion: Concomitant LSCT either in the form of CLAG or SLET appears to provide better long-term outcomes and is advocated while excision of extensive OSSN involving the limbus.