Abstract
Aim: To evaluate the outcomes of Conjunctival Limbal Autograft (CLAU) and Conjunctival Limbal Allograft (CLAL) transplants for the treatment of partial or total Limbal Stem Cell Deficiency (LSCD). Methods: Retrospective, cohort study. All eyes treated with limbal stem cell transplant (LSCT) that had 1 year follow-up or more were included. Visual success was measured by improvement in VA post operatively. Surgical success was defined as maintaining a healthy clear corneal surface post operatively. Results: There were 8 autolimbal and 9 allolimbal transplants. Of the latter, 8 were from living related donors (Lr-CLAL) and one was Keratolimbal Allograft (KLAL). Fifteen eyes had total LSCD and two eyes had partial LSCD. Primary diagnosis included combined chemical & thermal Injury burn (n=13), vernal keratoconjunctivits (n=2), herpes simplex infection (n=1) and idiopathic (n=1). Mean post operative follow-up was 50.65 ± 34.68 months (range 12- 108 months). CLAU was successful in 7 out of 8 eyes (87.5%). Mean VA improved from 0.1 ± 0.12 to 0.44 ± 0.28 (measured in decimal fraction). CLAL was successful in 2 out of 9 eyes (22.2%). Mean VA improved from 0.03 ± 0.04 to 0.10 ± 0.22. All eyes with CLAU achieved re-epithelialization and maintained an intact epithelium. Eyes with CLAL achieved re-epithelialization and maintained an intact epithelium in 66.7% (6). Conclusion: LSCT is an effective modality of treatment in patients with LSCD. CLAU transplant and absence of post operative complications were associated with statistically higher success rate. Younger patients and wet ocular surface had more favorable outcome.
Highlights
The corneal epithelial cells undergo constant renewal and regeneration
Fourteen patients (17 eyes) were included in our study as they were suffering from Limbal Stem Cell Deficiency (LSCD) requiring limbal stem cell transplant (LSCT)
LSCT was combined with Penetrating Keratoplasty (PKP) and Amniotic Membrane Transplant (AMT) in 2 eyes, and with superficial keratectomy combined with AMT in 13 eyes
Summary
The corneal epithelial cells undergo constant renewal and regeneration. Cells from the surface are desquamated and replaced by proliferating basal epithelial cells from the periphery. The cells undergo vertical and horizontal movements. This state of dynamic equilibrium is maintained by a sub-population of cells, the Limbal Stem Cells (LSCs), residing within the palisades of Vogt at the limbus. The basal limbal epithelium provides the source for corneal epithelial regeneration [1,2]. In patients with complete limbal stem cell destruction, corneal conjunctivalization accompanied by the invasion of goblet cells is inevitable [3]. In unilateral diseases; autologous material harvested from the healthy eye may be used. Allogeneic material must be transplanted [4,5,6,7]
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