Reconstruction of the corneal epithelium by limbal allograft transplantation for severe ocular surface disorders.
OBJECTIVE
Although penetrating keratoplasty is an established surgical procedure, it often is ineffective for severe ocular surface diseases such as alkali burns or limbal deficiency. The authors have performed limbal allograft transplantation for the reconstruction of the corneal epithelium.


METHODS
A total of nine patients (3 with chemical injury, 3 with limbal deficiency with unknown etiology, 2 with moderate ocular pemphigoid [OCP], and 1 with traumatic limbal deficiency) were treated by limbal allograft transplantation. Penetrating keratoplasties were performed in all patients with the exception of one with OCP. Patients received cyclosporine both systemically (10 mg/kg) and topically (0.05%) as well as high-dose intravenous dexamethasone (8 mg).


RESULTS
The corneal epithelium was reconstructed in all patients, although two showed partial increased fluorescein permeability and two others required a second surgery. The other five epithelia remained clear at mean follow-up of 12.3 months, with two episodes of graft rejection which were controlled successfully by medication.


CONCLUSIONS
Limbal allograft transplantation with intensive immunosuppression by cyclosporine and high-dose steroids appears to be a promising surgical intervention for the reconstruction of corneas affected by severe ocular surface disease.
Tsubota
K
K
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Toda
I
I
Saito
H
H
Shinozaki
N
N
Shimazaki
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002463:Cell Membrane Permeability; D002470:Cell Survival; D017690:Cell Transplantation / Q000379:methods; D003315:Cornea / Q000166:cytology*; D003316:Corneal Diseases / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004848:Epithelium / Q000637:transplantation; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016850:Limbus Corneae / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D014019:Tissue Donors; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D003907:Dexamethasone; D016572:Cyclosporine