3 YEARS EXPERIENCE WITH HOMOLOGOUS CENTRA L LIMBO-KERATOPLASTY IN THETREATMENT OF LIMBAL STEM-CELL DEFICIENCY

Background: Problems with epithelial healing are the main cause of cor neal graft failure in patients with limbal stem cell deficiency. This post-operative complication cannot be eliminated by conventional penet rating keratoplasty alone, but only by additional limbal grafting, whi ch is, however, highly immunogenic. We report here our 3 years' experi ence with a new surgical procedure which we developed called homologou s central limbo-keratoplasty. Patients and methods: We have performed 52 homologous central limbo-keratoplasties in patients with limbal ste m cell deficiency since February 1993. We report here the results of t he first 18 transplantations with the longest follow-up periods (mean 22 months). The unmatched donor cornea was trephined in a way such tha t 40 % of its circumference contained limbus. These grafts were then s utured centrally into the host cornea. Systemic cyclosporin A (CSA) wa s administered for at least 1 year after all transplantations. Results : Fourteen of the 18 grafts failed during the follow-up period. The re asons for graft failure were severe surface disorders (7), severe surf ace disorders in combination with endothelial immune reactions (5) and endothelial immune reactions alone (2). The four patients with centra lly clear grafts no longer receive systemic CSA with follow-up periods between 20 and 30 months. Conclusions: Central limbo-keratoplasty is a very promising procedure. However, the average results are not yet s atisfying, because the majority of limbal stem cells undergo rejection within 2 years. Improved results will be achievable in the future by using well-matched instead of non-matched transplants and by further i mproving immune modulation beyond the effectiveness of current CSA tre atment.