title: Early results of penetrating keratoplasty after cultivated limbal epithelium transplantation.
abstract: OBJECTIVE
  To describe the early results of penetrating keratoplasty (PKP) in patients who had previously undergone cultivated limbal epithelium transplantation.
  
  
  METHODS
  Medical records of patients with limbal stem cell deficiency due to chemical burns who underwent PKP after cultivated limbal epithelium transplantation were reviewed for demographics, primary etiology, type of limbal transplantation, ocular surface stability, visual acuity, graft clarity, and complications. Histopathologic features of the recipient corneal buttons were studied with special attention to epithelial status.
  
  
  RESULTS
  Of the 125 patients with limbal stem cell deficiency treated with cultivated limbal epithelium transplantation, 15 underwent PKP at a mean interval of 7 months (range, 2-12 months) following cultivated limbal epithelium transplantation (autologous, n = 11; allogenic, n = 4). All 4 patients treated with allogenic cultivated limbal epithelium transplantation were undergoing immunosuppressive therapy. Fourteen (93%) of the 15 eyes had a successful corneal graft with a stable corneal epithelium. Preoperative best-corrected visual acuity was less than 20/200 in 14 of the 15 eyes. At a mean +/- SD follow-up of 8.3 +/- 5.0 months after PKP, the best-corrected visual acuity was more than 20/60 in 8 eyes, 20/200 to 20/60 in 5 eyes, and less than 20/200 in 2 eyes. Three of the 15 eyes experienced corneal allograft rejection, which was managed successfully. One eye with graft rejection also had glaucoma. None of the limbal epithelial allografts showed signs of rejection.
  
  
  CONCLUSIONS
  Early results of PKP following cultivated limbal epithelium transplantation are favorable when performed after stabilizing the ocular surface. Adequate immunosuppression is essential for allogenic cultivated limbal epithelium transplantation to avoid rejection. Corneal allografts can separately reject the limbal allografts.
authors.affiliation: Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, Cornea and Anterior Segment Service, L V Prasad Eye Institute, Hyderabad, India. vsangwan@lvpei.org
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
authors.forename: Himanshu P
authors.initials: HP
authors.lastname: Matalia
authors.forename: Geeta K
authors.initials: GK
authors.lastname: Vemuganti
authors.forename: Ghazala
authors.initials: G
authors.lastname: Ifthekar
authors.forename: Anees
authors.initials: A
authors.lastname: Fatima
authors.forename: Shashi
authors.initials: S
authors.lastname: Singh
authors.forename: Gullapalli N
authors.initials: GN
authors.lastname: Rao
mesh_terms: D000293:Adolescent; D000328:Adult; D002478:Cells, Cultured; D002648:Child; D002675:Child, Preschool; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D019573:Epithelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015948:Keratoplasty, Penetrating; D016850:Limbus Corneae / Q000166:cytology*; D008297:Male; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000473:pathology; D014184:Transplantation, Homologous; D014792:Visual Acuity
chemical_list: D007166:Immunosuppressive Agents