Simultaneous Transplantation of Limbal Stem Cells May Reduce Recurrences of Granular Dystrophy After Corneal Transplantation

Abstract

To present 2 cases with long-term relapse-free intervals only after limbo-keratoplasty but not after conventional penetrating keratoplasty in granular dystrophy.Retrospective review of the patient charts and photographs taken during long-term follow-up of 2 cases with granular dystrophy, in which 1 eye received penetrating keratoplasty and the fellow eye received penetrating limbo-keratoplasty.In the first patient, 1 eye showed extensive recurrence of granular deposits 17 years after penetrating keratoplasty was performed while in the second eye two-thirds of the corneal transplant adjacent to the transplanted limbal area remained clear 12 years after the limbo-corneal transplant. In the second patient, 1 eye showed no signs of recurrence 5 years after limbo-keratoplasty, whereas a recurrence of granular corneal deposits occurred 18 months after surgery in the fellow eye.These cases show that the simultaneous transplantation of healthy donor limbus when performing penetrating keratoplasty may prolong recurrence in granular corneal dystrophy. Although we were unable to prove it on the molecular level, these clinical courses may support the hypothesis that a limbal transplant helps prevent a recurrence.

Management of Stromal Corneal Dystrophies; Review of the Literature with a Focus on Phototherapeutic Keratectomy and Keratoplasty

“…In the first case, the eye with PK showed a significant recurrence 17 years post-op, while most of the fellow cornea remained clear 12 years post-op. In the second case, the eye with PK showed a recurrence at 18 months, while the eye with limbo-keratoplasty was still clear 5 years post-op [ 78 ]. Spelsberg et al compared the outcome of limbo-keratoplasty in 16 GCD and 17 LCD cases with PK alone in 20 GCD and 16 LCD cases [ 51 ].…”

Limbal and corneal epithelial homeostasis

“…The superiority of LESCs hypothesis over the alternative CESCs hypothesis is best observed in penetrating keratoplasty. It is well known clinically that in the setting of limbal stem cell deficiency concurrent transplantation of limbal tissue is necessary [18, 19], and a penetrating keratoplasty in the setting of limbal stem cell deficiency is bound to fail eventually [20], indicating the vital role of LESCs for the long-term regeneration of the corneal epithelium. Therefore, based on the above evidence and our clinical and experimental observations, the LESCs hypothesis remains the most acceptable and appropriate model for explaining the mechanisms that regulate homeostasis and wound healing of the corneal epithelium.…”