Purpose: To evaluate the outcomes of living related conjunctival limbal all
ograft transplantation for the treatment of stem cell deficiency.
Design: Retrospective, noncomparative case series.
Participants: Nine living related donors, eight recipients (10 eyes) with S
tevens-Johnson syndrome (3 eyes), ectodermal dysplasia (3 eyes), chemical i
njury (2 eyes), ocular cicatricial pemphigoid (1 eye), and atopic keratocon
junctivitis (n = 1).
Intervention: Four clock hours of limbal conjunctival tissue from the best
matched human leukocyte antigen (HLA) relative donor were transplanted to t
he recipient eye superiorly and inferiorly after conjunctival peritomy and
removal of conjunctival pannus. Systemic cyclosporine was administered to a
ll recipients.
Main Outcome Measures: Restoration of corneal epithelium, reduction of vasc
ularity and conjunctivalization, improved comfort, improved corneal clarity
, and visual improvement.
Results: Mean follow-up period was 26.2 months. Two highly inflamed eyes fa
iled to initially epithelialize. The remainder all survived with restoratio
n of corneal epithelium and reduction of vascularization. Corneal opacifica
tion was reduced (four of eight eyes) and visual improvement was achieved i
n seven eyes. All five eyes with pain had an improvement in symptoms. Allog
raft rejection occurred in two eyes (25%), and both were treated successful
ly. Both eyes had two class I HLA mismatches, and both had an underlying di
agnosis of Stevens-Johnson syndrome. One eye developed a recurrent epitheli
al defect and perforated, requiring a penetrating keratoplasty that remaine
d clear with an intact epithelial surface. The two initial failures also pe
rforated and required penetrating keratoplasties that failed. None of the d
onor eyes had any complications.
Conclusions: Restoration of the ocular surface by HLA-matched conjunctival
limbal allograft transplantation can be accomplished in selected recipients
. Systemic cyclosporine, even at low doses, is useful in ensuring long-term
survival. Ophthalmology 2001;108:126-134 (C) 2001 by the American Academy
of Ophthalmology.