Early Results of Co–Cultivated Limbal and Conjunctival Epithelium Transplantation

Abstract

Abstract: : Purpose: To describe the early results of co–cultivated (limbal+conjunctival) epithelial transplantation. Methods: Medical records of 22 patients who underwent co–cultivated (limbal+conjunctival) epithelium transplantation, were reviewed for demographics, etiology, type of limbal transplantation, vision and ocular surface stability and complications. Histopathology of the recipient corneal buttons was studied for the epithelial status. Results: Twenty–three eyes of the 22 patients underwent co–cultivated (limbal+conjunctival) epithelial transplantation (autograft n=20, living related allograft n=3) for limbal stem cell deficiency (LSCD) with a mean follow–up of 11.5 months (±4.4 SD). The etiology of LSCD was chemical burns (n=20), resolved infectious keratitis (n=2) and burnt out vernal kerato–conjunctivitis (n=1). Preoperative visual acuity was <20/200 in 21(91.3%) eyes and [[Unable to Display Character: &#61619;]]20/200 in 2(8.7%) eyes. Sixteen of the 23(69.6%) eyes had symblephara ranging from 2 to 10 clock hours. Twenty of the 23(87%) eyes had total LSCD. Patients with allografts were immunosuppressed. Six eyes underwent penetrating keratoplasty after a mean duration of 9 months (4–11 months). Postoperatively, one patient had corneal allograft rejection, 2 patients had recurrence of symblephara, and one patient developed microbial keratitis and one patient developed glaucoma. Visual acuity at last follow–up was less than 20/200 in 13(56.5%) eyes and better than 20/200 in 10(43.5%) eyes. At the last follow–up 10 of the 23(43.5%) eyes had failure and 13 of the 23(56.5%) eyes had success. Conclusions:Severe ocular surface disorders with LSCD can be treated by a novel approach of transplantation of co–cultivated limbal and conjunctival epithelium. However long term results are still awaited. Adequate immunosuppression is essential after allogenic transplantation to avoid rejection.

Keywords: cornea: clinical science • cornea: epithelium • conjunctiva