LIMBAL TRANSPLANTATION

Background: Limbal transplantation is a surgical technique of ocular s urface epithelial transplantation advocated for a variety of ocular su rface disorders with presumed stem-cell deficiency. Limbal transplanta tion was performed in 18 patients with ocular surface disease, which i ncluded aniridia keratopathy, chronic contact lens-associated epitheli opathy, chemical injury, Stevens-Johnson syndrome, and corneal intraep ithelial dysplasia. Methods: Limbal allograft transplantation was perf ormed in nine eyes with the use of heterologous limbal tissue from cad averic donor eyes or live relatives, whereas nine eyes underwent conve ntional limbal autograft transplantation. Results: Limbal allograft tr ansplantation resulted in restoration of a stable ocular surface in se ven of nine cases, with early visual rehabilitation and significant re duction in symptoms. At a mean follow-up period of 14.7 months, one pa tient was noted to have failure of the inferior graft related to posto perative microbial keratitis, whereas one patient had an acute rejecti on episode after early cessation of oral cyclosporine. The mean follow -up period for limbal autografts was 27.1 months. Limbal autograft fai lure occurred in two patients with limbal autograft transplantation fo r chronic contact lens-associated epitheliopathy. One contact lens wea rer had epithelial dysplasia in the fellow eye at the previous donor s ite. Subclinical involvement of the fellow eye is suggested as a reaso n for graft failure and donor eye complications in these eyes. Conclus ion: Although it requires a longer follow-up period, limbal allograft transplantation is a viable procedure for bilateral ocular surface dis ease and for presumed bilateral disease (viz bilateral exposure to inj urious agents) and may be a preferred alternative to limbal autograft transplantation for such patients. The role of immunosuppression is be ing evaluated.