Figure 5.

Prevention and management of symblepharon-associated progressive recurrence of limbal stem cell deficiency (LSCD) after simple limbal epithelial transplantation (SLET). The top row shows similar cases of total unilateral limbal stem cell deficiency (LSCD) with severe symblepharon extending from the lids to the cornea (a to d). In the first two instances (a, b), excellent recurrence-free long-term outcomes are seen when SLET is combined with conjunctival autografting (CAG, e,f). However, in cases of the next two cases (c, d), recurrence of LSCD along with the symblepharon are seen when SLET alone is performed (g, h). in such cases, CAG should always be combined with SLET to prevent recurrence of LSCD. The third row shows four cases of early recurrence of symblepharon after 3–6 months of SLET (i to l), which were treated successfully with CAG, shown in corresponding images of the fourth row (m to p). Since the late failure of SLET is almost always due to recurrence of previously unaddressed symblepharon, it is important to look for early recurrence and treat it using CAG and not by repeating SLET