Early Results of Penetrating Keratoplasty Following Cultivated Limbal Epithelium Transplantation

Abstract

Abstract: : Purpose: To describe the early results of penetrating keratoplasty (PKP) in the patients who had previously undergone cultivated limbal epithelial transplantation. Methods: Medical records of 15 patients with limbal stem cell deficiency (LSCD) due to chemical, who underwent PKP following cultivated limbal epithelium transplantation, were reviewed for demographics, primary etiology, type of limbal transplantation, ocular surface stability, visual acuity, graft clarity and complications. Histopathology of the recipient buttons was studied with special attention to epithelial status. Results: Of the 125 patients with limbal stem cell deficiency treated with cultivated limbal epithelium transplantation, 15 underwent PKP at a mean interval of 7.0(range 2–12) months following cultivated limbal epithelium transplantation (autologous n=11, allogenic n=4). All four patients with allogenic cultivated limbal epithelium transplantation were on immunosuppressive therapy. Fourteen of the 15(93.3%) eyes had successful corneal graft with stable corneal epithelium. Preoperative best–corrected visual acuity was 20/60 in eight eyes, 20/200 to 20/60 in five eyes and was < 20/200 in two eyes. At a mean follow up of 8.3 months (± 5.0SD) following PKP, the best corrected visual acuity improved to >20/60 in eight eyes, 20/200 to 20/60 in five eyes and was <20/200 in two eyes. Three of the 15 eyes had corneal allograft rejection, which was managed successfully. One eye with graft rejection also had glaucoma. None of the limbal epithelial allografts showed signs of rejection. Conclusions:Early results of PKP following cultivated limbal epithelium transplantation are favorable when performed after stabilizing the ocular surface. Adequate immunosuppression is essential for allogenic cultivated limbal epithelium transplantation to avoid rejection. Corneal allografts can reject separately to the limbal epithelial allografts.

Keywords: cornea: epithelium • cornea: clinical science • transplantation