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Limbal stem cell transplantation improves vision, corneal clarity
Ophthalmology. 2010;117(6):1207-1213.
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Limbal stem cell transplantation in patients with ocular surface disease improves vision and corneal clarity alone or in conjunction with other therapies, a study showed.
"Autografts have the best long-term outcome followed by [living related donor] allografts," the study authors said. "Cadaver donor allografts have a comparatively poor outcome. This may partly reflect the difference in case mix between unilateral and bilateral [ocular surface] conditions."
The retrospective cohort study included 27 eyes of 26 patients with unilateral or bilateral total limbal stem cell deficiency that underwent limbal stem cell transplantation and had at least 1 year of follow-up.
The group comprised 12 autolimbal and 15 allolimbal transplants. Among the allolimbal transplants, nine were from living related donors and six were from cadaver donors.
Indications for surgery included chemical injury, aniridia-related keratopathy, trachoma, contact lens wear, steam injury, ophthalmia neonatorum, radiation, chronic keratitis, chronic inflammation and ocular surface intraepithelial neoplasia.
Limbal stem cell transplantation was performed alone in nine eyes and in conjunction with penetrating keratoplasty or amniotic membrane transplantation in 18 eyes.
Surgical success was defined by the longevity of a healthy corneal epithelium after transplantation. Visual success was gauged by visual acuity gains achieved in operated eyes during the mean follow-up of 38 months. Mean follow-up was 47 months for autolimbal grafts, 32.6 months for living related donor grafts and 28.1 months for cadaver donor grafts.
Study data showed overall limbal stem cell transplantation survival in 22 eyes (82%). All eyes undergoing autolimbal transplants showed complete re-epithelialization of the cornea within 2 months. The corneal surface failed in five eyes with allolimbal grafts, including one eye with a living related donor graft and four eyes with cadaver donor grafts.
Mean visual acuity improved from 0.121 preoperatively to 0.313 postoperatively, the authors reported.
Grafts of limbal tissue are transplanted in cases of conjunctival destructive disease (chemical burns, Stevens-Johnson) to restore stem cells for regeneration of a healthy corneal epithelium. These grafts can be taken from the healthy, fellow eye (autograft) or a living related donor or cadaver donor when disease is bilateral. This study demonstrates that autografts have the highest success rate in these procedures followed by living related and cadaver donors. This is not surprising, given that bilateral disease has a tendency to be more widespread in the case of systemic conjunctival destructive disorders or more severe in the case of trauma. Also noted by the authors is the tendency for all grafts to have a higher success rate when performed on an uninflamed recipient eye. This study confirms the validity of the common approach to limbal transplantation — to prefer first the use of a limbal autograft and an uninflamed ocular surface.
– John A. Hovanesian, MD, FACS
OSN
Cornea/External Disease Board Member