Aaron Sobol, MD
  Corneal and Refractive Surgery


Improving lives through modern technology   

Dr. Sobol is a Board Certified Ophthalmologist practicing in Uniontown Pennsylvania. 

He provides medical and surgical care for eye disease and evaluates people for disorders of the visual system.

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 Tuesday, October 2, 2007

Stem cell transplant   
A patient with severe eczema and chronic corneal irritation had two prior transplants OD and one OS.  Presented two years ago with severe vascularization with opacification OU and he had poor healing and chronic epithelial defects after the first grafts.  The left eye also had a perforation.  Hand motions/light perceptions pre-op.

Here's his pre-op photo.  I gave him a limbal stem cell allograft. Dr. Tseng's lab in Miami did the limbal impression cytology.

Here he is 6 months after the allograft, the grafts are at 3 and 9 o'clock.  Note the smooth and avascular corneal epithelium.  I placed the grafts in the interpalpabral fissure for cosmesis.He was lost to follow-up immediately after the surgery and did not get any immunosuppressants.  The graft survived well.

Then the new corneal graft. 

The photo is out-of focus but you can see the cornea is clear centrally. The patient was lost to follow-up (again) for six months after the PKP and there is some haze in the graft from 3 to 6 o'clock but he is happy with his vision.  The epithelium has survived two years without immunosuppressives.  Best vision is (I think) 20/80. 

He has a similar presentation OS and I gave him a stem cell transplant in that eye five months ago.  Here's the post-op photo OS.  We'll go for a triple procedure soon.  This one will be more challenging as there is a white liquid cataract and a very shallow chamber with anterior synechiae to the peripheral cornea from his prior perforation.

That's keratinized conjunctiva temporally.

alsobol at 12:54 PM | | | Permalink