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Allogeneic Penetrating Limbo-keratoplasty
Reinhard T., Sundmacher R.,
Heinrich-Heine-Universität Düsseldorf, Universitäts-Augenklinik (Düsseldorf)
After conventional penetrating keratoplasty the limbal stem cells of the host must completely substitute the graft epithelium within 12 to 18 months postoperatively. In limbal stem cell insufficiency, therefore, limbal stem cell transplantation performed before or simultaneously with penetrating keratoplasty is a premise for long-term rehabilitation. Autologous limbal stem cell transplantation is recommended for unilateral diseases. In bilateral diseases, however, allogeneic transplantation is necessary. Allogeneic penetrating limbo-keratoplasty offers the possibility to easily transplant cornea and limbal stem cells in a one-stage procedure. Trephination of the graft is performed with diameters of 7.7 to 10.0 mm in order to have limbal stem cells in about 40% of the circumference. Thereafter, the graft is sutured in the central host cornea. Immune reactions against donor endothelial and limbal stem cells have to be expected as main postoperative complications. An effective prophylaxis of immune reactions, therefore, is a premise for long-term success. Since February 1993 we have performed 48 allogeneic penetrating limbo-keratoplasties in patients with limbal stem cell insufficiency. The results could be considerably improved with long-term application of topical steroids, mid-term application of systemic immunosuppressives and use of HLA-matched grafts. With these prophylactic measures more than half of the patients experiences long-term central clear graft survival.