Challenges and Treatment Options for Chemical Burn-Induced Corneal Stem Cell Deficiency

Q: Challenges and Treatment Options for Chemical Burn-Induced Corneal Stem Cell Deficiency

Hello： I apologize for not being an expert in this area, so I am not very clear about the treatments and cannot provide you with accurate answers. <br>1. <br>National Taiwan University Hospital may not recommend surgery because it carries risks that could negatively affect vision

Issues Following Chemical Burns to the Cornea

Hello Doctor: My eyes have suffered from chemical burns, and after treatment at Taipei National Taiwan University Hospital, I currently have issues with limbal stem cell deficiency in both eyes.
The right eye has only a mild deficiency with almost complete stem cells, while the left eye has a more severe limbal stem cell deficiency, leading to conjunctival and vascular proliferation that causes poor vision.
Since I am from Hsinchu, I followed up at the National Taiwan University Hsinchu Branch after discharge.
During the follow-up, I asked the doctor if there were other treatment options for my left eye, but I received a negative response.
After researching related medical techniques online, I found out about limbal stem cell transplantation and autologous oral mucosal stem cell ex vivo culture techniques, so I sought consultation at Far Eastern Memorial Hospital.
However, Far Eastern Memorial Hospital only performs limbal stem cell transplantation, taking half of the limbal stem cells from the right eye to transplant into the left eye, and they mentioned that if the surgery fails, then they would consider the oral mucosal stem cell ex vivo culture technique.
Since the right eye also has stem cell deficiency issues, I then went to Chang Gung Memorial Hospital in Taipei, hoping to undergo the oral mucosal stem cell ex vivo culture technique, but the doctor suggested that I first try wearing a scleral lens to see if it could improve my condition.
I would like to ask: 1.
Why did National Taiwan University Hospital not recommend surgery and mention that donating from the right eye could potentially lead to blindness? 2.
Why does Far Eastern Memorial Hospital only perform limbal stem cell transplantation and consider the oral mucosal stem cell ex vivo culture technique only if the surgery fails, instead of doing the latter from the beginning? 3.
At Chang Gung Memorial Hospital, why is there a similar issue, and why not directly perform the oral mucosal stem cell ex vivo culture technique instead of first trying the scleral lens?

Hong Zhi Yuan, 40~49 year old female. Ask Date: 2023/03/31

Dr. Gao Pilin reply Ophthalmology

Hello: I apologize for not being an expert in this area, so I am not very clear about the treatments and cannot provide you with accurate answers.
1.
National Taiwan University Hospital may not recommend surgery because it carries risks that could negatively affect vision.
The risk of potential blindness in the right eye after donation is due to the possibility of damage to the corneal surface during the transplant surgery, which may impact the donor's own vision.
2.
Far Eastern Memorial Hospital may only perform limbal stem cell transplantation because they have more experience with this technique and believe it is the most suitable method for the patient.
The consideration of other methods only if the surgery fails may be due to the higher risks associated with those alternatives.
3.
Chang Gung Memorial Hospital may suggest that patients first try wearing scleral lenses because this is a simpler and lower-risk approach.
If this method helps improve the patient's symptoms, it could avoid the need for more complex surgeries.
Additionally, it may be that Chang Gung Memorial Hospital believes scleral lenses are more appropriate for the patient's condition or that they consider the patient unsuitable for other treatment options.

Reply Date: 2023/03/31

More Info

Chemical burns to the eyes can lead to significant complications, including corneal stem cell deficiency, which can severely impact vision. The management of such conditions often involves a multidisciplinary approach and can vary based on the severity of the injury and the specific circumstances of the patient.
1. Why did National Taiwan University Hospital (NTUH) not recommend surgery and mention the risk of blindness after donating stem cells from the right eye?
The decision to avoid surgery, especially in cases involving corneal stem cell deficiency, is often based on a careful assessment of the risks versus benefits. In your case, the right eye has only mild stem cell deficiency, and the potential for further damage or loss of vision from surgical intervention may outweigh the benefits. Surgeons typically prioritize preserving as much healthy tissue as possible, especially when the risk of complications, such as blindness, is significant. The concern is that if the right eye were to suffer further damage during the harvesting of stem cells, it could lead to irreversible vision loss.

2. Why does A-Yang Hospital only perform limbal stem cell transplantation and consider oral mucosal stem cell culture only if the surgery fails?
The rationale behind this approach is likely due to the complexity and risks associated with stem cell transplantation. Limbal stem cell transplantation is a well-established procedure that can restore the ocular surface effectively when there is a deficiency. However, it requires a healthy donor site, which in your case is the right eye. The oral mucosal stem cell technique is more complex and may not be as readily available or as straightforward as limbal transplantation. By attempting the limbal transplantation first, the medical team can evaluate its effectiveness before considering more invasive or experimental procedures.

3. Why did Chang Gung Memorial Hospital suggest trying scleral lenses before proceeding with oral mucosal stem cell culture?
Scleral lenses can provide a temporary solution for patients with corneal surface issues by creating a fluid reservoir over the cornea, which can help protect it and improve vision. This conservative approach allows the medical team to assess whether the lenses can alleviate symptoms and improve visual acuity without immediately resorting to more invasive procedures. If the scleral lenses do not provide sufficient improvement, then the team may consider more advanced treatments, such as oral mucosal stem cell transplantation.

In summary, the management of corneal stem cell deficiency following chemical burns is complex and requires careful consideration of the risks and benefits of each treatment option. The approach taken by your healthcare providers reflects a cautious strategy aimed at preserving vision while exploring the most effective treatment modalities. It is essential to maintain open communication with your medical team, express your concerns, and discuss all available options thoroughly. If you feel uncertain about the recommendations, seeking a second opinion from another specialist in ocular surface diseases may also provide additional insights and options for your treatment plan.

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