Conjunctival-limbal autograft

To provide an overview of conjunctival-limbal autografting (CLAU) for ocular surface rehabilitation with emphasis on more recent literature detailing outcomes of the procedure over the last 2 decades as well as technique variations and adjuvant techniques.

Limbal autografting initially described in 1964 by Barraquer and Strampelli and later popularized by Kenyon and Tseng is considered the best option for restoration of corneal phenotype in unilateral limbal stem-cell deficiency. Although there have been developments in alternative limbal epithelial stem-cell techniques including ex-vivo tissue engineering methods, because of the benefit of immunohistocompatability, this procedure still provides better long-term outcomes. As autograft donor tissue is valuable, optimization of the recipient eye preoperatively with good lid closure and reduction of inflammation is vital for success as is close postoperative follow-up. Variations in the technique described have included the modified Cincinnati technique combining CLAU with cadaveric keratolimbal allograft to avoid conjunctivalization. In addition, simple limbal epithelial autograft transplantation, a less-invasive technique combined with amniotic membrane transplantation, has shown promise.

In spite of the development of new epithelial transplant techniques, in unilateral limbal stem-cell deficiency, CLAU from a healthy unaffected fellow eye remains the best option available for restoration of corneal phenotype.