Long-term Follow-up of Living-related Limbal Allografts for Treatment of Bilateral Limbal Stem Cell Deficiency

Abstract

Abstract: : Purpose: To report the clinical outcome of a 5-year follow up of 11 living-related limbal allografts treated with topical and systemic immunosuppression. Methods: From December 1996 to December 1997 we enrolled in the study 11 patients affected by bilateral limbal stem cells deficiency (8 chemical burns, 3 Stevens-Johnson and Lyell syndromes, 1 cicatricial pemhpigoid, 1 aniridia). The mean age of the recipients was 58 years (25-72 years), 7 patients were male and 4 were female. The limbal donor tissue was obtained from brothers/sisters in 9 patients and from siblings in 2 cases. The surgery was done simultaneously according to the technique proposed by Kenyon and Tseng. Systemic immunosuppression was based on methylprednisolone 1 mg/kg/day and cyclosporine 2mg/kg/day. Topical dexamethasone was given every two hours combined with antibiotics TDS until reepithelialization occurred. Topical steroids and systemic cyclosporine was maintained for the entire period of the study. Results: After one year, 4/11 (36,3%) patients failed with recurrence of the fibrovascular pannus and five patients suffered of mild rejection which subsided after treatment. After 3, years 9/11 (81.8%) patients were considered clinically and cytologically failed. At the end of the follow up (5 years), all patients are clinically and cytologically failed. Conclusions: Despite the initial encouraging results, we report a total failure of living-related limbal allografts after 5 years of follow-up. Reasons for failure should include acute and chronic rejection, persistent inflammation and tear film impairment. For the future, improvement of strategies of immunosuppression, better control of inflammation, new answers for the treatment of dry eye, and cell therapy should offer more chances of success in these challenging cases. At the present these results should suggest a careful approach and a thorough information when planning the surgery since the required systemic immunosuppression has several potential risks when used on a long-standing regimen.

Keywords: cornea: epithelium