[Homologous central limbo-keratoplasty in limbus stem cell damage. Retrospective study of 3 years' experience].
BACKGROUND
Problems with epithelial healing are the main cause of corneal graft failure in patients with limbal stem cell deficiency. This post-operative complication cannot be eliminated by conventional penetrating keratoplasty alone, but only by additional limbal grafting, which is, however, highly immunogenic. We report here our 3 years' experience with a new surgical procedure which we developed called homologous central limbokeratoplasty.


METHODS
We have performed 52 homologous central limbo-keratoplasties in patients with limbal stem cell deficiency since February 1993. We report here the results of the first 18 transplantations with the longest follow-up periods (mean 22 months). The unmatched donor cornea was trephined in a way such that 40% of its circumference contained limbus. These grafts were then sutured centrally into the host cornea. Systemic cyclosporin A (CSA) was administered for at least 1 year after all transplantations.


RESULTS
Fourteen of the 18 grafts failed during the follow-up period. The reasons for graft failure were severe surface disorders (7), severe surface disorders in combination with endothelial immune reactions (5) and endothelial immune reactions alone (2). The four patients with centrally clear grafts no longer receive systemic CSA with follow-up periods between 20 and 30 months.


CONCLUSIONS
Central limbo-keratoplasty is a very promising procedure. However, the average results are not yet satisfying, because the majority of limbal stem cells undergo rejection within 2 years. Improved results will be achievable in the future by using well-matched instead of non-matched transplants and by further improving immune modulation beyond the effectiveness of current CSA treatment.
Sundmacher
R
R
Augenklinik, Heinrich-Heine-Universität Düsseldorf.
Reinhard
T
T
Althaus
C
C
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003318:Corneal Opacity / Q000209:etiology; D016039:Corneal Transplantation / Q000379:methods* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000473:pathology
Homologe zentrale Limbokeratoplastik bei Limbusstammzellschäden. Retrospektive auf 3 Jahre Erfahrung.