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Long-term Survival of Donor Epithelial Cells after Homologous Penetrating Limbo-keratoplasty in Severe Limbal-stem Cell Insufficiency
1Reinhard T., 1Kontopoulos T., 1Spelsberg H., 2Berschick P., 3Henke L., 1Sundmacher R.,
1Heinrich-Heine-Universität Düsseldorf, Universitäts-Augenklinik (Düsseldorf)
2Landeskriminalamt NRW (Düsseldorf)
3Institut für Blutgruppenforschung (Köln)
Background: Since 1991, homologous penetrating limbo-keratoplasty has been performed in 48 patients with severe limbal stem cell insufficiency. Here, long-term results are presented for the first time.
Patients: All patients received systemic Cyclosporin A and/or Mycophenolate mofetil in the postoperative course. In 12 patients grafts with 0-1 HLA-mismatches in the HLA A, B and DR loci, in 13 patients grafts with 2-6 mismatches and in 23 patients untyped grafts were used. Long-term clear graft survival was estimated according to Kaplan and Meier. In 7 patients epithelial cells were harvested from the surface of the grafts in order to perform moleculargenetic anaysis.
Results: Five years postoperatively, 59% of the grafts with 0-1 mismatches, 41% of the grafts with 2-6 mismatches and 18% of the untyped grafts were centrally clear (log-rank-test, p=0.09). In the epithelium of 5 of 7 patients with moleculargenetic analysis DNA from the donor could be found up to 56 months postoperatively.
Conclusions: Long-term survival of donor epithelium could be demonstrated for the first time after homologous penetrating keratoplasty using moleculargenetic methods. HLA-matched grafts seem to deliver better results than untyped grafts. Improvement of tissue matching may possibly further improve current results.