Penetrating limbo-keratoplasty for granular and lattice corneal dystrophy: survival of donor limbal stem cells and intermediate-term clinical results.
OBJECTIVE
To assess clinical follow-up data, and to identify donor epithelial cells after homologous penetrating central limbo-keratoplasty in patients with granular and lattice corneal dystrophies compared with patients who underwent conventional penetrating keratoplasty (PK).


METHODS
Mixed retrospective and prospective nonrandomized comparative case series.


METHODS
Twenty-six patients who underwent 33 limbo-keratoplasty procedures for granular or lattice corneal dystrophy since May 1995 and a historical control group of 24 patients who underwent 36 PK procedures between November 1986 and May 1995.


METHODS
Postoperatively, all but 2 limbo-keratoplasty patients were treated with systemic immunosuppressants for 6 months. All patients received long-term topical immune prophylaxis with prednisolone-21-acetate 1% (2 drops per day). After obtaining informed consent, epithelial cells were harvested from 10 limbo-keratoplasty eyes of 8 patients with granular dystrophy and 7 limbo-keratoplasty eyes of 7 patients with lattice dystrophy. Conjunctival epithelium or buccal mucosal epithelium for recipient identification and corneal epithelial cells from 3 graft sites were harvested. Deep-frozen donor corneoscleral rims were analyzed to characterize donor features. Genetic analysis was performed by polymerase chain reaction of short tandem repeat (STR) loci.


METHODS
The ratio of dystrophy recurrences in the graft was clinically assessed. Donor features in epithelial cells were genetically established if at least 1 STR profile differed from that of the recipient.


RESULTS
There were 5 recurrences in limbo-keratoplasty eyes with granular dystrophy and 2 recurrences in limbo-keratoplasty eyes with lattice dystrophy, compared with 15 and 6 recurrences in PK eyes, respectively. The differences between limbo-keratoplasty and PK were not statistically significant over time (log-rank test; P = 0.14 for granular dystrophy and P = 0.56 for lattice dystrophy; alpha error, 0.05). For genetic analysis, 12 of 17 samples were evaluated. Donor epithelial cells were detected in 5 of the 12 samples (42%).


CONCLUSIONS
Limbo-keratoplasty tended to be associated with fewer recurrences of granular and lattice dystrophies. However, the difference was not yet statistically significant, probably due to the disappearance of the transplanted limbal stem cells over time. Genetic analysis confirmed the survival of transplanted limbal stem cells over several years in some limbo-keratoplasty eyes, which might correlate with less recurrence. Limbo-keratoplasty, therefore, is likely to represent a first step towards long-term recurrence-free survival of corneal grafts in patients with granular and lattice dystrophies.
Eye Hospital, Heinrich-Heine University Duesseldorf, Germany. spelsber@uni-duesseldorf.de
Helga
H
Spelsberg
Thomas
T
Reinhard
Lotte
L
Henke
Peter
P
Berschick
Rainer
R
Sundmacher
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002470:Cell Survival / Q000502:physiology; D003228:Conjunctiva / Q000166:cytology; D003317:Corneal Dystrophies, Hereditary / Q000235:genetics / Q000601:surgery*; D016172:DNA Fingerprinting; D004848:Epithelium; D019573:Epithelium, Corneal / Q000166:cytology* / Q000502:physiology; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015948:Keratoplasty, Penetrating / Q000379:methods*; D016850:Limbus Corneae / Q000166:cytology*; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011239:Prednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000166:cytology* / Q000502:physiology; D014019:Tissue Donors
D007166:Immunosuppressive Agents; C009935:prednisolone acetate; D011239:Prednisolone