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Management of Aniridic Management of Aniridic Keratopathy with Keratopathy with Allograft Limbal Stem Allograft Limbal Stem Cell Transplantation Cell Transplantation Followed by Followed by PhacoemulsificationPhacoemulsification SurgerySurgery
Sibel Aksoy, MD, Yonca A. Akova, MD Baskent University, School of Medicine Department of Ophthalmology Ankara-Turkey
The authors acknowledge no financial interest in the subject matter of this
presentation
PurposePurpose
To report a case of aniridic keratopathy treated with allograft limbal stem cell transplantation (ALSCT) and medical theraphy including bevacizumab followed by phacoemulsification surgery for congenital cataract
CaseCase29 years-old female Presented to our clinic with blurred
vision and photophobia in both eyesVisual acuities were 20/60 in the
right eye and counting fingers at 1 meter in the left eye
Intraocular pressures were normal OD: Normal fundus findings
OS : Fundoscopic examination was not possible
Anterior Segment Anterior Segment ExaminationExaminationEpithelial defects
and cloudy cornea in the left eye
Paracentral and 3600 peripheral corneal neovascularization in the left eye
Bilateral aniridia Bilateral congenital
lamellar cataract
OD
OS
Left eye treated with superficial keratectomy, allogreft limbal stem cell transplantation and amniotic membrane transplantation
Topical lomefloxacin (4x1), topical dexamethasone (8x1), topical hydroxypropylmethilcellulose(8x1), oral cyclosporine A (3mg/kg) and oral metilprednisolone (0,5mg/kg)
Decreased gradually
SURGICAL TREATMENT MEDICAL TREATMENT
The day after surgery
Figures showing
amniotic
membrane
transplantation
and corneal
sutures of the
limbal graft at
superior temporal
and inferior nasal
quadrants
• VA: Finger counting from 2 meters
• Obvious reduction in vascularity
• Increased epithelization
• Decreased haze
Pre-therapy
Post-therapy
Postoperative 6 months
• Revascularization at the inferior and nasal quadrants
• Subconjunctival (0.04 mg/ 0.01ml) and topical bevacizumab (4x1) treatment were added
Postoperative1 year
Follow-up reduction of vascularization
Phacoemulsifica
tion and
intraocular lens
implantation
was performed
1.5 years after
ALSCT
Postoperative 6 Postoperative 6 monthsmonthsVisual acuity
increased to 20/200
Corneal epithelium was intact with minimal surface vascularity
No side effects of bevacizumab treatment were seen
ConclusionConclusionAniridia is a congenital, almost
always bilateral, pan-ocular and non-self limiting disease
ALSCT as well as systemic immunosuppression and bevacizumab therapy improved the aniridic keratopathy in our patient
It is a progressive disease and long term follow-up is needed
NAME: Sibel Aksoy, M.D.
TITLE: Resident in Ophthalmology
DATE AND PLACE OF BIRTH : November 20, 1979, Turkey
2002: Doctor of Medicine, Osmangazi University, School of Medicine, Eskisehir, Turkey
2004-2009: Resident, Baskent University, School of Medicine, Department of Ophthalmology, Ankara, Turkey
NAME: Yonca Aydın Akova, M.D.
TITLE: Professor in Ophthalmology
DATE AND PLACE OF BIRTH: October 21, 1960, Turkey
1983: Doctor of Medicine, Istanbul University, School of Medicine
1990: Istanbul University, School of Medicine, Department of Ophthalmology
2000:Professor of Ophthalmology, Baskent University, School of Medicine, Department of Ophthalmology, Ankara, Turkey
2002: Chairperson, Baskent University, School of Medicine, Department of Ophthalmology, Ankara, Turkey