Limbal stem cells transplantation in the reconstruction of the ocular surface: 6 years experience.

PURPOSE: To analyze the graft survival rate and stability of the corneal surface in patients who underwent limbal stem cell transplantation. Three surgical techniques were performed based on the origin of the ocular surface lesion: conjunctival limbal autograft (CLAU), living-related conjunctival limbal autograft (lr-CLAL), and keratolimbal allograft (KLAL) transplantations. METHODS: Nonrandomized consecutive comparative case series study. Eighty-four patients (90 eyes; 31 women and 53 men; age range: 11-78 years) were included in the study. Mean follow-up was 31.2 months (range: 6-72 months). Patients were divided into three groups: CLAU, lr-CLAL, and KLAL, comprising 21, 26, and 43 eyes, respectively. Graft survival rate and clinical success of the stem cell transplantation was confirmed by impression cytology. The Kaplan Meier survival curve and generalized Peto tests were used for the analyses. RESULTS: Graft survival rate and the regularity of the corneal surface differed significantly between the allo- and autografts. The 3-year and 6-year graft survival rates were 76.1% and 61.9%, respectively, for the autologous transplantation group, and 59.4% and 46.3%, respectively, for the allogeneic transplantation group. Corneal surface restoration correlated with positive staining for corneal epithelial cells in impression cytology. CONCLUSIONS: Significantly better long-term outcomes were achieved with autotransplantation of the limbus compared with allogeneic limbal grafts from living-related and cadaveric donors.

Deep lamellar keratoplasty for various corneal lesions.

PURPOSE: To evaluate the efficacy and safety of deep lamellar keratoplasty (DLK) as a method for treating various diseases of corneal stroma with unaffected endothelium. METHODS: DLK was performed in 31 eyes of 31 patients with corneal stroma opacity without endothelial abnormalities. Surgical procedures included deep removal of corneal stroma 7.5 mm in diameter with the use of viscoelastic or 0.02% trypan blue solution, exposing Descemet membrane in the central area of about 5 mm across including the area of pupil, and grafting a corneal lenticule. In three cases of postinflammatory stromal scars with coexisting limbal stem cell deficiency, limbal stem cell grafting was additionally performed. Main outcome measures were best-corrected visual acuity (BCVA) and postoperative astigmatism. RESULTS: Intraoperative perforation of Descemet membrane with the necessity of converting the procedure into penetrating keratoplasty occurred in five cases (16.1%) and one patient underwent penetrating keratoplasty on the seventh day after DLK due to persistent double anterior chamber. These six patients were excluded from the study. Postoperative BCVA ranged from 0.1 to 1.0 and astigmatism from 1.2 to 4.7 D. Postoperative complications were loose sutures, ocular hypertension, Descemet membrane detachment, and corneal melting. CONCLUSIONS: DLK is an effective procedure for treating various diseases of corneal stroma with unaffected endothelium. This technique as an extraocular procedure seems to be the treatment of choice in mentally retarded patients.

[Keratectomy for a malignant melanoma of the cornea]. / Keratektomia jako metoda leczenia czerniaka zlosliwego rogówki.

PURPOSE: To present the possibility of malignant melanoma treatment of the cornea using keratectomy. MATERIAL AND METHODS: A 59-year old woman with a primary malignant melanoma of the cornea. Visual acuity before surgery 0.2. Malignant melanoma was removed using keratectomy. Follow-up 18 months. RESULTS: Satisfactory cosmetic result and visual acuity 1.0 was obtained. In 18 months follow-up no local or general symptoms of tumor recurrence are observed. CONCLUSION: Keratectomy should be considered as an alternative treatment for primary malignant melanoma of the cornea.

Corneal grafting and aggressive medication for corneal defects in graft-versus-host disease following bone marrow transplantation.

PURPOSE: To evaluate the clinical outcomes of corneal grafting for severe dry eye complications in bone marrow transplant recipients. METHODS: Eleven eyes of nine patients with severe corneal complications of chronic graft-versus-host disease were treated from 2000 to 2005. The subjects underwent penetrating keratoplasty (n=9 eyes; seven for perforation and two for leucoma) or deep anterior lamellar keratoplasty (n=2 eyes) for deep postinflammatory stromal scarring without endothelial abnormalities. Patients were observed for graft survival, visual acuity, and postoperative complications. RESULTS: During the follow-up period (mean=21.6 months), nine grafts (82%) remained clear or almost entirely clear and gained more than two logarithmic units of best-corrected visual acuity. Two regrafts were necessary as the primary grafts became cloudy after 9 and 11 months. Persistent epithelial defects occurred in seven eyes (64%), cataract in six (55%), ocular hypertension in five (45%), corneal calcareous degeneration in two (18%), loss of clarity in two (18%), and sterile ulceration in one (9%). CONCLUSION: Corneal grafting was effective for restoring corneal clarity and improving visual function in this series of patients. Although the complication ratio was high and some patients required regrafting, there was a clinical improvement in the majority of patients.

Deep lamellar keratoplasty for various corneal lesions.

PURPOSE: To evaluate the efficacy and safety of deep lamellar keratoplasty (DLK) as a method for treating various diseases of corneal stroma with unaffected endothelium. METHODS: DLK was performed in 31 eyes of 31 patients with corneal stroma opacity without endothelial abnormalities. Surgical procedures included deep removal of corneal stroma 7.5 mm in diameter with the use of viscoelastic or 0.02% trypan blue solution, exposing Descemet membrane in the central area of about 5 mm across including the area of pupil, and grafting a corneal lenticule. In three cases of postinflammatory stromal scars with coexisting limbal stem cell deficiency, limbal stem cell grafting was additionally performed. Main outcome measures were best-corrected visual acuity (BCVA) and postoperative astigmatism. RESULTS: Intraoperative perforation of Descemet membrane with the necessity of converting the procedure into penetrating keratoplasty occurred in five cases (16.1%) and one patient underwent penetrating keratoplasty on the seventh day after DLK due to persistent double anterior chamber. These six patients were excluded from the study. Postoperative BCVA ranged from 0.1 to 1.0 and astigmatism from 1.2 to 4.7 D. Postoperative complications were loose sutures, ocular hypertension, Descemet membrane detachment, and corneal melting. CONCLUSIONS: DLK is an effective procedure for treating various diseases of corneal stroma with unaffected endothelium. This technique as an extraocular procedure seems to be the treatment of choice in mentally retarded patients. (Eur J Ophthalmol 2004; 14: #-72).