Donor Site Complications in Autolimbal and Living-Related Allolimbal Transplantation

Abstract

To study the long-term changes at donor sites and safety implications for donor eyes used for harvesting tissue for autologous and living-related donor limbal transplants. Retrospective, observational, consecutive case series. We examined 50 donor sites of limbal tissue belonging to 25 healthy eyes (23 human subjects). The corneas and limbus of donor eyes were assessed for symptoms and visual acuity and examined by slit-lamp biomicroscopy and in vivo confocal microscopy with particular emphasis on the donor sites and central cornea. In the donor eyes, we assessed visual acuity, persistence of symptoms, stability of the corneal epithelium, and the clinical and microscopic changes that occurred at the donor sites. Mean follow-up was 41±38 months (median, 24; range, 3-127). All eyes had symptoms of ocular discomfort up to 4 weeks postoperatively and remained asymptomatic thereafter. No patient reported subjective reduction in visual acuity. Mean best-corrected visual acuity (logarithm of the minimum angle of resolution fraction) preoperatively was 0.076±0.19 and postoperatively was 0.09±0.17 (P = 0.57). All donor sites showed re-epithelialization of the peripheral denuded limbus within 2 weeks. Observed complications were filamentary keratitis and subconjunctival hemorrhage in 4 eyes. In vivo confocal microscopy confirmed that the central corneal epithelium remained normal in all eyes. The re-epithelialized donor site was covered with conjunctival epithelium in 17 sites of 10 eyes and with corneal epithelium in 7 sites of 5 eyes. Limbal donation of 2 clock-hours of the superior and inferior limbus with 3×3 mm of adjacent conjunctiva was a safe procedure in this group of patients, demonstrating stable vision and an intact corneal epithelium during the follow up period. Donor sites can be re-epithelized by multiple layers of either corneal or conjunctival epithelium and is associated with deep stromal scarring.