Combined Surgery of the Penetrating Keratoplasty and the Limbal Cell Transplantation

ABSTRACT

If the corneal opacity and the corneal neovascularization are severe and broad, it should be taken the penetrating keratoplasty. But there is a high risk of the persistent epithelial defect, the neovascularization and the rejection. Recently, there were many reports that support the limbal stem cell theory. Based on the stem cell conception of the corneal epithelium, the authors have evaluated the clinical effects of the penetrating keratoplasty combined with the allograftic limbal transplantation or the penetrating keratoplastty combined with the autologousl imbal transplantation in 4 patients (4 eyes) whose corneas were severly opaque and heavily neovasculized. As a result, the visual improvement was achieved in 3 eyes (as a corrected vision, from hand motion to finger count, from hand motion to 0.05, from hand motion to 0.15), the prompt reepithelialization was accomplished in 3 eyes (the mean time 5.7 days) and even in case of the failed reepithelialization, the epithelial side at which the limbal transplantion was done showed a rapid recovery. Therefore we think that the combined surgery of the panetrating keratoplasty and the limbal transplantation is useful because it can increase the success rate of the penetrating keratoplasty by the rapid and firm reepithelialization and the suppression of the neovascularization. Futhermore the donor cornea can be used effectively (the central portion is used for a penetrating keratoplasty and the limbal portion is used for a limbal transplantation), and we can expect a rapid visual recovery through a simultaneous surgery of the two other operation.