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. 2000 Mar;84(3):273–278. doi: 10.1136/bjo.84.3.273

Autologous limbal transplantation in patients with unilateral corneal stem cell deficiency

H Dua, A Azuara-Blanco
PMCID: PMC1723416  PMID: 10684837

Abstract

AIM—To describe a surgical technique for autologous limbal stem cell transplantation and the outcome of a series of patients with unilateral stem cell deficiency.
METHODS—A report of six consecutive patients who underwent autologous limbal stem cell transplantation is presented. The primary diagnosis included alkali burn (n=3), conjunctival intraepithelial neoplasia (CIN) (n=1), recurrent pterygium (n=1), and contact lens induced keratopathy (n=1). The autologous transplanted tissue consisted of peripheral cornea, limbus, and conjunctiva obtained from the contralateral eye. Three of the above patients underwent penetrating keratoplasty in association with auto-limbal transplantation. A significant modification to established techniques was the close monitoring of conjunctival epithelial migration in the immediate postoperative period. If conjunctival epithelium threatened to migrate on to the corneal surface, it was mechanically removed at the slit lamp and prevented from crossing the limbus. This was required in three patients.
RESULTS—The mean follow up was 18.8 months. The outcome was satisfactory in all cases: a stable corneal surface was restored and there was a substantial improvement in vision and symptoms. One patient had a primary failure of the corneal allograft associated with glaucoma, and 6 months later developed a retinal detachment. No complications were noted in the donor eye with the exception of one patient who developed filamentary keratitis along the edge of the donor site.
CONCLUSION—Autologous limbal transplantation with corneal, limbal, and conjunctival carriers was found to be useful for ocular surface reconstruction, over a mid-term follow up, in patients with unilateral stem cell deficiency. Close monitoring of the migration of conjunctival epithelium in the immediate postoperative period, and preventing it from crossing the limbus, ensured that the corneal surface was re-epithelialised exclusively from epithelial cells derived from the transplanted limbal tissue. This approach should improve the success of this procedure.



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Figure 1  .

Figure 1  

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(a) Diagram illustrating the placement of auto-limbal explants at the 6 and 12 o'clock positions of recipient eye. (b) Auto-limbal transplant with corneal graft. The graft is usually 7 mm in size as the peripheral 2 mm, both above and below, is covered by the explants.

Figure 2  .

Figure 2  

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Fluorescein stained ocular surface photographs of recipient eye that had undergone auto-limbal transplantation. On day 2 following surgery, donor epithelial cells can be seen migrating on to the recipient surface from the explants placed at the 6 o'clock (a) and 12 o'clock (b) positions. Arrows indicate the anterior edge of the explants. On day 4 following surgery, host conjunctival epithelial cells can be seen migrating from the edge (arrows) of the recessed conjunctiva on both the temporal (c) and nasal (d) sides. The advancing conjunctival epithelial sheets were mechanically debrided with a surgical blade (e), leaving behind the limbal explant derived expanding corneal epithelial cells (arrows). (f) The circumferentially migrating limbal explant derived corneal epithelial cells have met temporally and nasally. The large corneal epithelial defect healed with corneal cells and the small nasal conjunctival defect healed with conjunctival cells. Healing was complete by day 8. 

Figure 3  .

Figure 3  

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(a) Preoperative photograph of the eye of a patient with alkali burn and a large persistent corneal epithelial defect. (b) Intraoperative photograph showing recessed conjunctiva and removal of fibrovascular tissue from the corneal surface. (c) After removal of fibrovascular tissue, the underlying corneal stroma is found to be clear and transparent. (d) Intraoperative photograph showing auto-limbal explants sutured in place at the 6 and 12 o'clock positions. (e) Postoperative photograph after corneal epithelial healing was complete (taken 1 month after surgery).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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