Limbal transplantation

Background: Limbal transplantation is a surgical technique of ocular surface epithelial transplantation advocated for a variety of ocular surface disorders with presumed stem-cell deficiency. Limbal transplantation was performed in 18 patients with ocular surface disease, which included aniridia keratopathy, chronic contact lens-associated epitheliopathy, chemical injury, Stevens-Johnson syndrome, and corneal intraepithelial dysplasia. Methods: Limbal allograft transplantation was performed in nine eyes with the use of heterologous limbal tissue from cadaveric donor eyes or live relatives, whereas nine eyes underwent conventional limbal autograft transplantation. Results: Limbal allograft transplantation resulted in restoration of a stable ocular surface in seven of nine cases, with early visual rehabilitation and significant reduction in symptoms. At a mean follow-up period of 14.7 months, one patient was noted to have failure of the inferior graft related to postoperative microbial keratitis, whereas one patient had an acute rejection episode after early cessation of oral cyclosporine. The mean follow-up period for limbal autografts was 27.1 months. Limbal autograft failure occurred in two patients with limbal autograft transplantation for chronic contact lens-associated epitheliopathy. One contact lens wearer had epithelial dysplasia in the fellow eye at the previous donor site. Subclinical involvement of the fellow eye is suggested as a reason for graft failure and donor eye complications in these eyes. Conclusion: Although it requires a longer follow-up period, limbal allograft transplantation is a viable procedure for bilateral ocular surface disease and for presumed bilateral disease (viz bilateral exposure to injurious agents) and may be a preferred alternative to limbal autograft transplantation for such patients. The role of immunosuppression is being evaluated.