title: Early results of penetrating keratoplasty following limbal stem cell transplantation.
abstract: OBJECTIVE
  To describe the early results of penetrating keratoplasty (PKP) in patients who had earlier received limbal transplantation (LT).
  
  
  METHODS
  Prospective, non-comparative interventional case series comprising of four patients with limbal stem cell deficiency (LSCD) due to chemical injury (Cases 1, 2, 4) and xeroderma pigmentosum (Case 3). Cadaveric kerato-limbal allografts or living-related conjunctival-limbal allografts were done in four eyes followed by PKP for visual rehabilitation 3-4.5 months later. The following details were noted: demographics, primary aetiology, type of limbal transplant (cadaveric or living-related), immunosuppression, vision and ocular surface stability before and after LT and PKP, surgical complications and outcome of PKP.
  
  
  RESULTS
  Three eyes received living-related conjunctival-limbal allotransplantation and one received cadaveric kerato-limbal allograft. Duration of follow up after PKP ranged from 4 to 11 months. Visual acuity improved in the early postoperative period in all patients but reduced in 2 due to endothelial rejection and after trans-scleral cyclophotocoagulation for medically uncontrolled glaucoma. The ocular surface remained stable in all patients. All patients were started on immunosuppression on the first postoperative day. This was continued till the last follow-up visit. Post-PKP complications were punctate epithelial keratopathy, corneal allograft rejection and secondary glaucoma (one patient each).
  
  
  CONCLUSIONS
  Satisfactory visual rehabilitation is possible after PKP following LT without compromising ocular surface stability. However, a prolonged and close follow-up is warranted to avert complications.
authors.affiliation: Cornea and Anterior Segment Service, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad 500-034, India. vsangwan@lvpei.org
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
authors.forename: Merle
authors.initials: M
authors.lastname: Fernandes
authors.forename: Aashish K
authors.initials: AK
authors.lastname: Bansal
authors.forename: Geeta K
authors.initials: GK
authors.lastname: Vemuganti
authors.forename: Gullapalli N
authors.initials: GN
authors.lastname: Rao
mesh_terms: D000328:Adult; D002057:Burns, Chemical / Q000601:surgery; D002102:Cadaver; D003228:Conjunctiva / Q000637:transplantation; D005126:Eye Burns / Q000139:chemically induced / Q000601:surgery; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D016850:Limbus Corneae / Q000601:surgery*; D019520:Living Donors; D008297:Male; D011446:Prospective Studies; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014983:Xeroderma Pigmentosum / Q000601:surgery