Early Autologous Conjunctival Grafting in Complete Limbal Stem Cell Deficiency Secondary to Thermochemical Injury

A 33-year-old man who had a thermochemical burn from a Roman candle firework injury to the left eye (OS) presented with a complete epithelial defect and 360-degree limbal blanching, raising concern for complete limbal stem cell deficiency (LSCD). BSCVA was 20/150 (OS). A conjunctival graft was obtained from the superior bulbar conjunctiva of OD for grafting of OS. At postoperative week 6 (POW6), 80% of the conjunctiva and 80% of the corneal surface were epithelialized. At postoperative month 11 (POM11), the cornea was fully covered with a thin layer of conjunctiva. At POM16, he underwent a modified Cincinnati procedure with conjunctival limbal autograft (CLAU) and keratolimbal allograft (2 KLAL-Pro segments). One month later, his BSCVA improved to 20/25. Examination showed a fully epithelialized cornea without conjunctivalization, inferior stromal neovascularization, and mild residual anterior stromal haze. Conclusions: Early autologous conjunctival grafting on the cornea may protect against corneal decompensation after acute thermochemical injury by providing a healthy conjunctival epithelial barrier, without the need for invasion of injured bulbar conjunctiva and Tenon. It also provides a clear plane for later dissection of corneal conjunctivalization when ready to proceed with ocular surface stem cell transplantation (OSST), which may decrease the need for subsequent keratoplasty procedures.