Limbal allografting from related live donors for corneal surface reconstruction

Abstract

Objective To report the results of limbal allograft transplantation, from human leukocyte antigen (HLA)-matched and -unmatched related live donors, in patients with ocular surface disease due to chemical burns and Stevens-Johnson syndrome. Design Retrospective, noncomparative case series. Participants Eight patients (nine eyes) with severe chemical burns (n = 7 eyes) and Stevens-Johnson syndrome (n = 2 eyes). Intervention Recipient eyes were treated with excision of cicatricial tissues. Transplantation of superior and inferior limbal grafts was performed from related live HLA-matched (n = 7) and -unmatched donors (n = 2). Systemic cyclosporine was not used in any of the recipients. Main outcome measures Reconstruction of corneal surface epithelium, restoration of avascularity, increase in ocular comfort, and improvement in visual acuity. Results With a mean observation period of 17.2 months, phenotypically corneal epithelium, decreased vascularization of the corneal surface, and improved ocular comfort were seen in seven (77.8%) eyes. In all seven eyes, gradual recurrence of peripheral corneal vascularization occurred during the follow-up period. Features of graft rejection developed in three (42.9%) of these seven eyes. In two eyes, limbal transplantation from HLA-unmatched donors failed to reconstitute the corneal surface. Limbal allograft transplantation resulted in visual acuity of 20/400 or greater in only two (22.2%) eyes at last follow-up. Corneal grafts performed 7 and 16 months after successful limbal transplantation in two eyes developed recurrent epithelial breakdown and superficial corneal scarring. None of the donor eyes in this study had any complication. Conclusion Transplantation of limbal tissue from related live donors successfully reconstructs the corneal surface in HLA-matched recipients. Recurrence of vascularization on long-term follow-up probably results from inadequate stem cell transfer, immune-mediated stem cell damage, or both. Limbal allografting is best performed by transplanting the entire limbus from a cadaveric donor eye with systemic immunosuppression of the recipient, even if the donor is HLA-compatible.