V 424
Keratolimbal autograft and allograft transplantations for burns and other ocular surface disorders
J. Marek, J. Oficjalska-Mlynczak, H. Zajac-Pytrus, M. H. Nizankowska
Destruction of stem cells, located at the basal layer of corneal limbal epithelium, leads to persistent epithelial defect, ingrowth of conjunctival epithelium, neovascularization of the cornea and chronic inflammation. Conservative medical treatment in limbal stem cell deficiency cases is ineffective and prognosis for conventional penetrating keratoplasty is very poor. We present our experience with surgical treatment of severe ocular disorders by autologic and allogenic keratolimbal transplantation.
Patients and methods: In Department of Ophthalmology Wroclaw Medical University we performed 4 keratolimbal autografts and 5 allografts. Limbal stem cell deficiency was caused in 8 eyes by chemical burn and in 1 case by ocular cicatricial pemphigoid. 3 keratolimbal allografts were combined with penetrating keratoplasty. Our surgical technique was modification of original Kenyon and Tseng method. For autograft procedure part of limbal tissue was resected from uninjured partner eye. For allograft transplantation the whole ring of limbal tissue was harvested from multiorgan donor eyes. Post-operatively, immunosupressive therapy with corticosteroids and cyclosporine was administered.
Results: In all cases corneal epithelium healed completely in 3-6 weeks, vision considerably improved, pain and irritation of the eye regressed. In one case, after discontinuation of general immunosupressive therapy, occurred graft rejection
Conclusions: Keratolimbal transplantation allows reepithelialization of persistent epithelial defect and improves prognosis for penetrating keratoplasty. Surgical reconstruction of the corneal surface results in resolution of chronic inflammation, regression of corneal neovascularization and improves visual acuity. The course of epithelial healing supports limbal stem cell theory. Further research is indicated to determine the duration and dosage of immunosupresive therapy.
Department of Ophthalmology Wroclaw Medical University, ul. Chalubinskiego 2a, 50-368 Wroclaw, Poland