Living related conjunctival limbal allograft for the treatment of stem cell deficiency

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.