Titre du document / Document title

Limbal allografting from related live donors for corneal surface Reconstruction

Auteur(s) / Author(s)

RAO S. K. ⁽¹⁾ ; RAJAGOPAL R. ⁽¹⁾ ; SITALAKSHMI G. ⁽¹⁾ ; PADMANABHAN P. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Cornea Service, Sankara Nethralaya, Medical Research Foundation, Chennai, INDE

Résumé / Abstract

Objective: To report the results of limbal allograft transplantation, from human leukocyte antigen (HLA)-matched and -unmatched related live donors, in patients with ocular surface disease due to chemical burns and Stevens-Johnson syndrome. Design: Retrospective, noncomparative case series. Participants: Eight patients (nine eyes) with severe chemical burns (n = 7 eyes) and Stevens-Johnson syndrome (n = 2 eyes). Intervention: Recipient eyes were treated with excision of cicatricial tissues. Transplantation of superior and inferior limbal grafts was performed from related live HLA-matched (n = 7) and -unmatched donors (n = 2). Systemic cyclosporine was not used in any of the recipients. Main Outcome Measures: Reconstruction of corneal surface epithelium, restoration of avascularity, increase in ocular comfort, and improvement in visual acuity. Results: With a mean observation period of 17.2 months, phenotypically corneal epithelium, decreased vascularization of the corneal surface, and improved ocular comfort were seen in seven (77.8%) eyes. In all seven eyes, gradual recurrence of peripheral corneal vascularization occurred during the follow-up period. Features of graft rejection developed in three (42.9%) of these seven eyes. In two eyes, limbal transplantation from HLA-unmatched donors failed to reconstitute the corneal surface. Limbal allograft transplantation resulted in visual acuity of 20/400 or greater in only two (22.2%) eyes at last follow-up. Corneal grafts performed 7 and 16 months after successful limbal transplantation in two eyes developed recurrent epithelial breakdown and superficial corneal scarring. None of the donor eyes in this study had any complication. Conclusion: Transplantation of limbal tissue from related live donors successfully reconstructs the corneal surface in HLA-matched recipients. Recurrence of vascularization on long-term follow-up probably results from inadequate stem cell transfer, immune-mediated stem cell damage, or both. Limbal allografting is best performed by transplanting the entire limbus from a cadaveric donor eye with systemic immunosuppression of the recipient, even if the donor is HLA-compatible.

Revue / Journal Title

Ophthalmology   ISSN 0161-6420   CODEN OPHTDG 

Source / Source

1999, vol. 106, n^o4, pp. 822-828 (28 ref.)

Langue / Language

Anglais

Editeur / Publisher

Elsevier, New York, NY, ETATS-UNIS  (1976) (Revue)

Mots-clés anglais / English Keywords

Anatomical reconstruction ; Cornea ; Homograft ; Related donor ; Rim of sclera ; Treatment ; Stevens Johnson syndrome ; Chemical burn ; Eye ; Human ; Surgery ; Graft ; Skin disease ; Bullous dermatosis ; Eye disease ; Stomatology ; Trauma ;

Mots-clés français / French Keywords

Reconstruction anatomique ; Cornée ; Homogreffe ; Donneur apparenté ; Limbe sclérocornéen ; Traitement ; Ectodermose érosive pluriorificielle ; Brûlure chimique ; Oeil ; Homme ; Chirurgie ; Greffe ; Peau pathologie ; Dermatose bulleuse ; Oeil pathologie ; Stomatologie ; Traumatisme ;

Mots-clés espagnols / Spanish Keywords

Reconstrucción anatómica ; Córnea ; Homoinjerto ; Donador relacionado ; Limbo esclerocorneal ; Tratamiento ; Ectodermosis erosiva pluriorificial ; Quemadura química ; Ojo ; Hombre ; Cirugía ; Injerto ; Piel patología ; Dermatosis bulosa ; Ojo patología ; Estomatología ; Traumatismo ;

Localisation / Location

INIST-CNRS, Cote INIST : 18914, 35400008347016.0340