Long-term outcomes of autolimbal and allolimbal transplants

Objective: To evaluate the long-term results of limbal stem cell transplantation (LSCT) in patients with ocular surface (OS) disease.

Design: Retrospective consecutive cohort study.

Participants: 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.

Methods: 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.

Main outcome measures: 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.

Results: 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.

Conclusions: 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.