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Virender S. Sangwan, MS; Himanshu P. Matalia, MS; Geeta K. Vemuganti, MD; Ghazala Ifthekar, MSc; Anees Fatima, MSc; Shashi Singh, PhD; Gullapalli N. Rao, MD

Arch Ophthalmol. 2005;123:334-340.

Objective  To describe the early results of penetrating keratoplasty (PKP) in patients who had previously undergone cultivated limbal epithelium transplantation.

Methods  Medical records of patients with limbal stem cell deficiency due to chemical burns who underwent PKP after cultivated limbal epithelium transplantation were reviewed for demographics, primary etiology, type of limbal transplantation, ocular surface stability, visual acuity, graft clarity, and complications. Histopathologic features of the recipient corneal buttons were studied with special attention to epithelial status.

Results  Of the 125 patients with limbal stem cell deficiency treated with cultivated limbal epithelium transplantation, 15 underwent PKP at a mean interval of 7 months (range, 2-12 months) following cultivated limbal epithelium transplantation (autologous, n = 11; allogenic, n = 4). All 4 patients treated with allogenic cultivated limbal epithelium transplantation were undergoing immunosuppressive therapy. Fourteen (93%) of the 15 eyes had a successful corneal graft with a stable corneal epithelium. Preoperative best-corrected visual acuity was less than 20/200 in 14 of the 15 eyes. At a mean ± SD follow-up of 8.3 ± 5.0 months after PKP, the best-corrected visual acuity was more than 20/60 in 8 eyes, 20/200 to 20/60 in 5 eyes, and less than 20/200 in 2 eyes. Three of the 15 eyes experienced corneal allograft rejection, which was managed successfully. One eye with graft rejection also had glaucoma. None of the limbal epithelial allografts showed signs of rejection.

Conclusions  Early results of PKP following cultivated limbal epithelium transplantation are favorable when performed after stabilizing the ocular surface. Adequate immunosuppression is essential for allogenic cultivated limbal epithelium transplantation to avoid rejection. Corneal allografts can separately reject the limbal allografts.

Author Affiliations: Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory (Drs Sangwan, Matalia, and Vemuganti and Mss Ifthekar and Fatima), Cornea and Anterior Segment Service (Drs Sangwan and Rao), and Ophthalmic Pathology Laboratory (Dr Vemuganti), L V Prasad Eye Institute, and Center for Cellular and Molecular Biology (Dr Singh), Hyderabad, India.

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