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. 1995 Nov;79(11):977–982. doi: 10.1136/bjo.79.11.977

Surgical management of ocular surface disorders using conjunctival and stem cell allografts.

D J Coster 1, R K Aggarwal 1, K A Williams 1
PMCID: PMC505310  PMID: 8534667

Abstract

AIMS--The aim of this work was to investigate different surgical options for the repair of the ocular surface, using various extensions of the procedure of limbal stem cell allotransplantation. METHODS/RESULTS--Straightforward lamellar limbal transplantation was performed in one patient with contact lens induced limbal stem cell failure. A second patient with a neoplastic corneal lesion underwent limbal allotransplantation, followed later by a second procedure in which 360 degrees of limbus and the entire ocular surface was transplanted. A third patient who had suffered extensive chemical burns was treated by penetrating keratoplasty to restore central corneal clarity, followed later by a lamellar allograft comprising a 360 degrees annulus of peripheral cornea to repair the ocular surface. A fourth patient with long standing, chronic trachomatous eye disease underwent allotransplantation of the upper lid tarsal plate and conjunctiva, with reconstruction of the fornix. Finally, a child with Goldenhar's syndrome underwent reconstruction of the medial fornix with autologous buccal mucosa, followed by a lamellar corneal and conjunctival allograft. A stable ocular surface has been achieved in each case and there have been no obvious rejection episodes. CONCLUSION--Limbal allotransplantation can be extended to engraftment of the entire superficial cornea, limbus, conjunctiva, and tarsal plate in patients with a range of pathologies. We have described the surgical management of five cases which demonstrate the potential of the technique, but which raise questions which still need to be explored.

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Selected References

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  1. Jenkins C., Tuft S., Liu C., Buckley R. Limbal transplantation in the management of chronic contact-lens-associated epitheliopathy. Eye (Lond) 1993;7(Pt 5):629–633. doi: 10.1038/eye.1993.145. [DOI] [PubMed] [Google Scholar]
  2. Kenyon K. R., Tseng S. C. Limbal autograft transplantation for ocular surface disorders. Ophthalmology. 1989 May;96(5):709–723. doi: 10.1016/s0161-6420(89)32833-8. [DOI] [PubMed] [Google Scholar]
  3. Leone C. R., Jr Mucous membrane grafting for cicatricial entropion. Ophthalmic Surg. 1974 Summer;5(2):24–28. [PubMed] [Google Scholar]
  4. Levin P. S., Dutton J. J. Polytef (polytetrafluoroethylene) alloplastic grafting as a substitute for mucous membrane. Arch Ophthalmol. 1990 Feb;108(2):282–285. doi: 10.1001/archopht.1990.01070040134047. [DOI] [PubMed] [Google Scholar]
  5. Naumann G. O., Lang G. K., Rummelt V., Wigand M. E. Autologous nasal mucosa transplantation in severe bilateral conjunctival mucus deficiency syndrome. Ophthalmology. 1990 Aug;97(8):1011–1017. doi: 10.1016/s0161-6420(90)32471-5. [DOI] [PubMed] [Google Scholar]
  6. Pfister R. R. Corneal stem cell disease: concepts, categorization, and treatment by auto- and homotransplantation of limbal stem cells. CLAO J. 1994 Jan;20(1):64–72. [PubMed] [Google Scholar]
  7. Schermer A., Galvin S., Sun T. T. Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells. J Cell Biol. 1986 Jul;103(1):49–62. doi: 10.1083/jcb.103.1.49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Shore J. W., Foster C. S., Westfall C. T., Rubin P. A. Results of buccal mucosal grafting for patients with medically controlled ocular cicatricial pemphigoid. Ophthalmology. 1992 Mar;99(3):383–395. doi: 10.1016/s0161-6420(92)31962-1. [DOI] [PubMed] [Google Scholar]
  9. Thoft R. A. Conjunctival transplantation. Arch Ophthalmol. 1977 Aug;95(8):1425–1427. doi: 10.1001/archopht.1977.04450080135017. [DOI] [PubMed] [Google Scholar]
  10. Thoft R. A., Sugar J. Graft failure in keratoepithelioplasty. Cornea. 1993 Jul;12(4):362–365. doi: 10.1097/00003226-199307000-00014. [DOI] [PubMed] [Google Scholar]
  11. Thoft R. A., Wiley L. A., Sundarraj N. The multipotential cells of the limbus. Eye (Lond) 1989;3(Pt 2):109–113. doi: 10.1038/eye.1989.17. [DOI] [PubMed] [Google Scholar]
  12. Tsai R. J., Tseng S. C. Human allograft limbal transplantation for corneal surface reconstruction. Cornea. 1994 Sep;13(5):389–400. doi: 10.1097/00003226-199409000-00003. [DOI] [PubMed] [Google Scholar]
  13. Tseng S. C. Concept and application of limbal stem cells. Eye (Lond) 1989;3(Pt 2):141–157. doi: 10.1038/eye.1989.22. [DOI] [PubMed] [Google Scholar]

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