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Title

Visual rehabilitation using a scleral contact lens following cultivated limbal stem cell transplantation.

Purpose	To describe a case of unilateral total limbal stem cell deficiency (LSCD) resolved by ocular surface reconstruction using cultured autologous limbal stem cells, corneal transplant and a scleral lens. To our knowledge, this is the first documented case of scleral lens usage in this pathology.
Methods	A 55-year-old, HIV-positive male suffered a unilateral alkali burn 16 years ago, resulting in a total LSCD. The patient had received a previous penetrating keratoplasty (PK) that ultimately failed to impede corneal conjunctivalization. Upon referral, diagnosis of LSCD was made on clinical grounds. We elected to perform an ex-vivo cultivated limbal epithelial stem cell transplantation (CLET) using a small limbal graft from the contralateral, healthy eye. To remove deep stromal scarring, the patient received a second PK one year after transplantation. One year later, the patient was fitted with a scleral lens.
Results	One year after PK, the patient’s vision had improved from hand movements initially to 0.5 with optimal correction, and the ocular surface was stable with a transparent corneal graft. Using a scleral lens, the patient’s best-corrected vision improved significantly from 0.5 to 1.0.
Conclusion	This case illustrates the fact that CLET can be successfully utilized to restore a stable corneal surface with consequent improvement in visual acuity, and this in cases of severe total LSCD such as chemical burns. Furthermore, it also highlights the beneficial role of scleral lenses to achieve excellent functional outcomes in these patients.
Conflict of interest	No

Authors 1

Last name	BALLET
Initials	B
Department	Universitair Ziekenhuis Antwerpen
City	Antwerpen

Authors 2

Last name	BEHAEGEL
Initials	J
Department	Universitair Ziekenhuis Brussel
City	Brussel

Authors 3

Last name	NI DHUBHGHAILL
Initials	S
Department	Universitair Ziekenhuis Antwerpen
City	Antwerpen