Anja Viestenz1, Christiane Kesper2, Thomas Hammer2, Joana Heinzelmann2, Sabine Foja2, Arne Viestenz2. 1. Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube Straße 40, 06120, Halle, Germany. anja.viestenz@uk-halle.de. 2. Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube Straße 40, 06120, Halle, Germany.
Abstract
PURPOSE: Limbal stem cell deficiency (LSCD) is a rare but extremely relevant disease of the eye. LSCD patients often require a variety of surgical procedures, including keratoplasty in some cases. However, the outcome of these surgeries, including opacification and revascularization, is often frustrating due to LSCD relapse. METHODS: We developed a new surgical technique for the treatment of LSCD in which partial allogenic limbal transplantation (ALT) is carried out as part of penetrating keratoplasty (PK). After the PK, 1-8 slices from the limbal tissue of the donor graft are prepared and placed under the double running sutures attaching the corneal graft. This procedure was performed on 14 patients with LSCD, caused by severe ocular burn in 5 cases and by infection in 9. Between one and eight limbal transplants were used depending on the extension of the LSCD. RESULTS: All 14 patients showed stable or increased visual acuity after the ALT surgery compared to their preoperative visual acuity. All of the grafts were integrated into the superficial corneal layers without progression of corneal vascularization beyond the limbal grafts. The median follow-up period was 12 months on average. CONCLUSION: The ALT method seems to be a promising surgical procedure for the treatment of patients with LSCD. It can be properly carried out in the context of keratoplasty and does not require a separate donor tissue. The ALT grafts may offer the possibility of constructing a new limbal region, resulting in stable or even increased visual acuity and the absence of corneal vascularization.
PURPOSE: Limbal stem cell deficiency (LSCD) is a rare but extremely relevant disease of the eye. LSCD patients often require a variety of surgical procedures, including keratoplasty in some cases. However, the outcome of these surgeries, including opacification and revascularization, is often frustrating due to LSCD relapse. METHODS: We developed a new surgical technique for the treatment of LSCD in which partial allogenic limbal transplantation (ALT) is carried out as part of penetrating keratoplasty (PK). After the PK, 1-8 slices from the limbal tissue of the donor graft are prepared and placed under the double running sutures attaching the corneal graft. This procedure was performed on 14 patients with LSCD, caused by severe ocular burn in 5 cases and by infection in 9. Between one and eight limbal transplants were used depending on the extension of the LSCD. RESULTS: All 14 patients showed stable or increased visual acuity after the ALT surgery compared to their preoperative visual acuity. All of the grafts were integrated into the superficial corneal layers without progression of corneal vascularization beyond the limbal grafts. The median follow-up period was 12 months on average. CONCLUSION: The ALT method seems to be a promising surgical procedure for the treatment of patients with LSCD. It can be properly carried out in the context of keratoplasty and does not require a separate donor tissue. The ALT grafts may offer the possibility of constructing a new limbal region, resulting in stable or even increased visual acuity and the absence of corneal vascularization.
Authors: Samantha Bobba; Nick Di Girolamo; Richard Mills; Mark Daniell; Elsie Chan; Damien G Harkin; Brendan G Cronin; Geoffrey Crawford; Charles McGhee; Stephanie Watson Journal: Clin Exp Ophthalmol Date: 2016-09-01 Impact factor: 4.207
Authors: Catherine J Jackson; Inger T Myklebust Ernø; Håkon Ringstad; Kim A Tønseth; Darlene A Dartt; Tor P Utheim Journal: Stem Cells Transl Med Date: 2019-12-04 Impact factor: 6.940