Ocular Surface Reconstruction in Graft-Versus-Host Disease With HLA-Identical Living-Related Allogeneic Cultivated Limbal Epithelium After Hematopoietic Stem Cell Transplantation From the Same Donor

Abstract

To report a case of HLA-identical allogeneic living-related ex vivo expanded limbal epithelium in ocular surface reconstruction for chronic graft-versus-host disease (cGVHD). Review the clinical findings in a 58-year-old woman with bilateral limbal stem cell deficiency caused by cGVHD who underwent ocular surface reconstruction on the left eye with cultivated limbal epithelial cells (LECs) on intact human amniotic membrane combined with extracapsular cataract extraction and intraocular lens implantation. LECs were harvested from a small biopsy of the same HLA-identical living-related donor who already donated peripheral blood cells for hematopoietic stem cell transplantation. At the present state, after a follow-up of 31 months, the patient shows a successful ocular surface reconstruction with a clear, smooth, and stable corneal ocular surface without recurrence of limbal stem cell deficiency. Nine months postoperatively, patients' corneal thinning progressed to a small perforation, which was successfully treated with a tectonic perforating keratoplasty combined with the removal of irritating lid lashes. The technique of HLA-typed allogeneic ex vivo expansion of LECs harvested from the same living-related donors who already donated hematopoietic stem cells offers a possibility to reconstruct ocular surface in cGVHD.