Surgical management of ocular surface disorders using conjunctival and stem cell allografts

The aim of this work was to investigate different surgical options for the repair of the ocular surface, using various extensions of the procedure of limbal stem cell allotransplantation.

Straightforward lamellar limbal transplantation was performed in one patient with contact lens induced limbal stem cell failure. A second patient with a neoplastic corneal lesion underwent limbal allotransplantation, followed later by a second procedure in which 360 degrees of limbus and the entire ocular surface was transplanted. A third patient who had suffered extensive chemical burns was treated by penetrating keratoplasty to restore central corneal clarity, followed later by a lamellar allograft comprising a 360 degrees annulus of peripheral cornea to repair the ocular surface. A fourth patient with long standing, chronic trachomatous eye disease underwent allotransplantation of the upper lid tarsal plate and conjunctiva, with reconstruction of the fornix. Finally, a child with Goldenhar's syndrome underwent reconstruction of the medial fornix with autologous buccal mucosa, followed by a lamellar corneal and conjunctival allograft. A stable ocular surface has been achieved in each case and there have been no obvious rejection episodes.

Limbal allotransplantation can be extended to engraftment of the entire superficial cornea, limbus, conjunctiva, and tarsal plate in patients with a range of pathologies. We have described the surgical management of five cases which demonstrate the potential of the technique, but which raise questions which still need to be explored.