Two Cases of Whole Corneo-Limbal Transplantation

Ja Young Lee; Mee Kum Kim; Won Ryang Wee

doi:10.3341/jkos.2011.52.10.1238

Journal List > J Korean Ophthalmol Soc > v.52(10) > 1008911

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Kim, and Wee: Two Cases of Whole Corneo-Limbal Transplantation

Original Article

J Korean Ophthalmol Soc 2011;52(10):1238-1243.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.10.1238

Two Cases of Whole Corneo-Limbal Transplantation

Ja Young Lee, MD, Mee Kum Kim, MD, PhD, Won Ryang Wee, MD, PhD

Department of Ophthalmology, Seoul National University College of Medicine, Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

Address reprint requests to Mee Kum Kim, MD, PhD Department of Ophthalmology, Seoul National University Hospital #28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2665, Fax: 82-2-741-3187, E-mail: kmk9@snu.ac.kr

Received 28 February 2011 Accepted 21 April 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the clinical outcomes of total corneolimbal transplantation in two cases.

Case summary

One patient, who previously underwent three rounds of penetrating keratoplasty and limbal transplantation for uncontrollable peripheral and central corneal melting, received total corneolimbal transplantation. The other patient who underwent penetrating keratoplasty with limbal transplanation for a chemical burn and who did not experience corneal perforation also received total corneolimbal transplantation. During the average 19 months of follow-up, cyclophotocoagulation was performed to control high intraocular pressure in both patients. Both eyes were tectonically maintained without further corneal destruction despite poor visual acuity and rejection.

Conclusions

Total corneolimbal transplantation may be an effective tectonic procedure for corneal melting. This procedure can be considered as another option for patients with corneal melting after failed limbal and corneal transplantation.

Keywords: Corneal melt, Corneo-limbal transplantation, Limbal transplantation failure, Limbus, Tectonic procedure

References

1. Castroviejo R. Total penetrating keratoplasty; a preliminary report. Am J Ophthalmol. 1951; 34:1697–706.

2. Burke JW. Total keratoplasty. Trans Am Ophthalmol Soc. 1920; 18:440–7.

3. Tsubota K, Satake Y, Kaido M, et al. Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation. N Engl J Med. 1999; 340:1697–703.

4. Tsai RJ, Tseng SC. Human allograft limbal transplantation for corneal surface reconstruction. Cornea. 1994; 13:389–400.

5. Kenyon KR, Tseng SC. Limbal autograft transplantation for ocular surface disorders. Ophthalmology. 1989; 96:709–22.

6. Lee S. Ophthalmic Plastic and Reconstructive Surgery. 1st ed.Seoul: Korean Society of Ophthalmic Plastic and Reconstructive Surgery;2004. p. 4.

7. Kuckelkorn R, Redbrake C, Schrage NF, Reim M. Keratoplasty with 11–12 mm diameter for management of severely chem-ical-burned eyes. Ophthalmologe. 1993; 90:683–7.

8. Vajpayee RB, Thomas S, Sharma N, et al. Large-diameter lamellar keratoplasty in severe ocular alkali burns: A technique of stem cell transplantation. Ophthalmology. 2000; 107:1765–8.

9. Kwitko S, Marinho D, Barcaro S, et al. Allograft conjunctival transplantation for bilateral ocular surface disorders. Ophthalmology. 1995; 102:1020–5.

10. Jager M. Corneal Langerhans cells and ocular immunology. Regional Immunol. 1992; 4:186–95.

11. Skeens HM, Holland EJ. Large-diameter penetrating keratoplasty: indications and outcomes. Cornea. 2010; 29:296–301.

12. Cobo M, Ortiz JR, Safran SG. Sclerokeratoplasty with maintenance of the angle. Am J Ophthalmol. 1992; 113:533–7.

13. Panda A, Sharma N, Angra SK, Singh R. Therapeutic sclerokeratoplasty versus therapeutic penetrating keratoplasty in refractory corneal ulcers. Aust N Z J Ophthalmol. 1999; 27:15–9.

14. Jonas JB, Rank RM, Budde WM. Tectonic sclerokeratoplasty and tectonic penetrating keratoplasty as treatment for perforated or pre-descemetal corneal ulcers. Am J Ophthalmol. 2001; 132:14–8.

15. Zerve BL, Belin MW, Ciolino JB. Boston Type 1 Keratoprosthesis study group. Results from the multicenter Boston type 1 keratoprosthesis study. Ophthalmology. 2006; 113:1779.

16. Greiner MA, Li J-Y, Mannis MJ. Longer term vision outcomes and complications with the Boston type 1 keratoprosthesis at the University of California, Davis. Ophthalmology. 2011; 118:1543–50.

Figure 1.

Preoperative anterior segment photographs show diffuse graft edema, limbal insuffiency (A), and loosened suture due to peripheral cornea thinning (B) (case 1).

Figure 2.

Anterior segment photograph 1 day after total cornea transplantation showing no leakage (case 1).

Figure 3.

Anterior segment photographs 21 months after total cornea transplantation with limbus shows mild corneal edema due to chronic rejection (A) and mild corneal epithelial defects (B), but no recurrence of peripheral corneal thinning (case 1).

Figure 4.

Preoperative anterior segment photograph shows dense inferior cornea infiltration and severe thinning especially in the superior and inferior cornea with loosened suture, severe limbal insuffiency with neovascularization (A), and corneal epithelial defects (B) (case 2).

Figure 5.

Anterior segment photograph after total cornea transplantation of a large diameter cornea graft and medial temporary tarsorrhapy (case 2).

Figure 6.

Anterior segment photograph 1 year and 5 months after total cornea transplantation shows cornea opacity and limbal neovascularization (A), minimal cornea epithelial erosion (B), and no recurrence of melting (case 2).

TOOLS

Similar articles