Limbal Transplantation: A Midterm Clinical Outcome with Continuous Systemic Immune Suppression

ABSTRACT

PURPOSE: To investigate the midterm outcome of limbal transplantation combined with continuous systemic immune suppression. METHODS: The medical records of 15 eyes in 14 patients who underwent limbal transplantation were reviewed retrospectively. All had been followed up for 6 months or more. Limbal transplantation was performed with 360 degrees of 0.19 mm partial corneal trephined tissues, accompanied with transient amniotic membrane transplantation. The procedure was accomplished with systemic cyclosporine or mycophenolate. We defined complete success as neither rejection nor epithelial defect; partial success as partial conjunctival ingrowth and neovascularization without epithelial defect; and graft failure as persistent epithelial defect or total conunctivalization with neovascularization. RESULTS: Mean age at surgery was 45.1 years. 9 eyes yielded complete success, 2 had partial success, and graft failure occurred in 4 on an average of 23.4 months postoperatively. Success including complete and partial success showed 67% incidence (4 of 6) of chemical burn, 33% (1 of 3) with Stevens-Johnson syndrome, and 100% (6 of 6) experienced another intractable ocular surface disease. Of 10 eyes (67%), which experienced graft rejection in an average of 2.7 months; 4 demonstrated full recovery with oral corticosteroid and enhanced immunosuppression, 2 presented with chronic graft rejection, and the other 4 ended in graft failure. CONCLUSIONS: Total success rate was revealed as 73.3% for on average 23.4 months in limbal transplantation with continuous systemic immune suppression, utilized for chronic intractable ocular surface disease.