Long-term Outcomes of Autolimbal and Allolimbal Transplants

Abstract

To evaluate the long-term results of limbal stem cell transplantation (LSCT) in patients with ocular surface (OS) disease. Retrospective consecutive cohort study. Case records of 27 eyes of 26 patients (19 males and 7 females) who presented with unilateral or bilateral total limbal stem cell deficiency and treated at the Department of Ophthalmology were examined. All eyes that were treated with LSCT and that had at least 1 year follow-up were included. There were 12 autolimbal and 15 allolimbal transplants. Of the latter, 9 were from living related donors (LRDs) and 6 were from cadaver donors (CDs). A total of 9 eyes underwent LSCT and penetrating keratoplasty (PKP), and 11 eyes underwent LSCT and amniotic membrane transplantation (AMT). Cataract extraction with implant was carried out in 4 eyes. Some eyes had more than 1 associated procedure. Nine eyes had LSCT only. Patients with allolimbal transplants also received systemic immunosuppression. Surgical success was measured by the duration for which a healthy corneal epithelium was maintained after LSCT. Visual success was measured by improvement in visual acuity (VA) in the operated eye during the follow-up period. The follow-up period of all eyes was up to 119 months (mean 38+/-35.9 months, median 24 months). Survival of LSCT, as determined by the maintenance of healthy corneal epithelium until last follow-up, was seen in 22 eyes (82%). The surface failed within 3 months in 4 eyes (1 with LRD and 3 with CD) and after 43 months in the fifth patient (with CD). Subsequently, 6 eyes required PKP to achieve their maximum visual potential. The VA (measured in decimal fraction) improved over a period of 1 year from a mean of 0.121 (standard deviation [SD] 0.184) preoperatively to a mean of 0.313 (SD 0.348) postoperatively. Limbal stem cell transplantation, in isolation or in combination with other procedures, is effective in improving corneal clarity and vision. Autografts have the best long-term outcome followed by LRD allografts. Cadaver donor allografts have a comparatively poor outcome. This may partly reflect the difference in case mix between unilateral and bilateral OS conditions.