Summary
Certain conclusions appear to be clear regardless of the planned surgical approach. The risk of graft rejection and/or recurrent surface disease is higher whenever penetrating keratoplasty is performed in the context of stem cell dysfunction and after a stem cell transplant. In both approaches, the risk of corneal graft rejection is higher than in the keratoplasty population in general. This mandates special considerations in the management of recipient immunosuppression and management of the ocular surface. Finally, larger studies with considerably longer follow-up will be necessary before the ideal surgical and adjunct medical regimens can be determined. It is clear that penetrating keratoplasty plays a significant role in the visual rehabilitative stage of stem cell transplantation. When corneal grafting is necessary after stem cell transplantation, meticulous attention must be paid to nurturing the ocular surface, and to immunosuppression, for the prevention of graft rejection.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Kenyon KR and Tseng SCG. Limbal autograft transplantation for ocular surface disorders. Ophthalmol 1989; 96:709–722.
Theng JT and Tan DT. Combined penetrating keratoplasty and limbal allograft transplantation for severe corneal burns. Ophthalmol Surg Lasers 1997; 28:765–768.
Tsubota K, Toda I, Saito H, Shinozaki N, Shimazaki J. Reconstruction of the corneal epithelium by limbal allograft transplantation for severe ocular surface disorders. Ophthalmol 1995; 102:1486–1496.
Tseng SCG, Prabhasawat P, Barton K, Gray T, Meller D. Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstructions in patients with limbal stem cell deficiency. Arch Ophthalmol 1998; 116:431–441.
Frucht-Pery J, Siganos SS. Salomon A, Scheman L, Brautbar C, Zauberman H. Limbal cell autograft transplantation for severe ocular surface disorders. Graefes Arch Clin Exp Ophthalmol 1998; 236:582–587.
Tsubota K, Satake Y, Kaido M, Shinozaki N, Shimmura S, Bissen-Miyajima H., Shimazaki J. Treatment of severe ocular surface disorders with corneal epithelial stem cell transplantation. N Engl J Med 1999; 340:1697–1703.
Croasdale CR, Schwartz GS, Malling JV, Holland EJ. Keratolimbal allograft: recommendations for tissue procurement and preparation by eye banks, and standard surgical technique. Cornea 1999; 18:52–58.
Rao SK, Rajagopal R, Sitalakshmi G, Padmanabhan P. Limbal allografting for related live donors for corneal surface reconstruction. Ophthalmol 1999; 106:822–828.
Reinhard T, Sundmacher R, Spelsberg H, Althaus C. Homologous penetrating central limbo-keratoplasty (HPCLK) in bilateral limbal stem cell insufficiency. Arch Ophthalmol Scand 1999; 77:663–667.
Rights and permissions
Copyright information
© 2002 Springer-Verlag New York, Inc.
About this chapter
Cite this chapter
Mannis, M.J. (2002). Penetrating Keratoplasty in Ocular Stem Cell Disease. In: Ocular Surface Disease Medical and Surgical Management. Springer, New York, NY. https://doi.org/10.1007/0-387-21570-0_23
Download citation
DOI: https://doi.org/10.1007/0-387-21570-0_23
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-95161-4
Online ISBN: 978-0-387-21570-9
eBook Packages: Springer Book Archive