1. Management of Aniridic Keratopathy with Allograft Limbal Stem Cell Transplantation Followed by Phacoemulsification Surgery 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

2. Purpose 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

3. Case 29 years-old female Presented to our clinic with blurred vision and photophobia in both eyes Visual 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

4. Anterior Segment Examination Epithelial defects and cloudy cornea in the left eye Paracentral and 360 0 peripheral corneal neovascularization in the left eye Bilateral aniridia Bilateral congenital lamellar cataract OD OS

5. Left eye treated with superficial keratectomy, allogreft limbal stem cell transplantation and amniotic membrane transplantation Topical lomefloxacin (4x1), topical dexamethasone (8x1), topical hydroxypropylmethil cellulose(8x1), oral cyclosporine A (3mg/kg) and oral metilprednisolone (0,5mg/kg) Decreased gradually SURGICAL TREATMENTMEDICAL TREATMENT

6. The day after surgery Figures showing amniotic membrane transplantation and corneal sutures of the limbal graft at superior temporal and inferior nasal quadrants

7. VA: Finger counting from 2 meters Obvious reduction in vascularity Increased epithelization Decreased haze Pre-therapy Post-therapy Postoperative 6 months

8. Revascularization at the inferior and nasal quadrants Subconjunctival (0.04 mg/ 0.01ml) and topical bevacizumab (4x1) treatment were added Postoperative 1 year

9. Follow-up reduction of vascularization Phacoemulsification and intraocular lens implantation was performed 1.5 years after ALSCT

10. Postoperative 6 months Visual acuity increased to 20/200 Corneal epithelium was intact with minimal surface vascularity No side effects of bevacizumab treatment were seen

11. Conclusion Aniridia 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

12. 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