Optical lamellar-penetrating keratoplasty with stem cell transplantation in high-risk cases

Background. Stem cells of the corneal epithelium are located mainly at the sclerocorneal limbus, and are essential for the maintenance of a healthy corneal surface. Limbal stem cell deficiency leads-depending on intensity and extension - to several corneal alterations. The appearance of limbal stem cell deficiency is chiefly concentrated on pemphigoids, Herpes relapses and alkali burns and represents the main part of high-risk keratoplasty. The different types of limbal stem cell deficiency (partial or total) are usually treated with several surgical techniques. Total limbal deficiency can be treated with limbal transplantation, either of the healthy eye (limbal autograft), or using material of another donor (limbal allograft). Methods and results. Lamellar-penetrating keratoplasty (L-P-KP) has been carried out in five patients. Unlike recent surgical techniques containing ring-shaped or circular transplantations, a stripe-like lamellar preparation was performed. L-P-KP involves a peripheral lamellar and a central penetrating keratoplasty combined with limbal stem cell transplantation. In four of six cases, the transplant has been successfully kept clear without the occurrence of corneal decompensation or ulceration. No major changes could be seen between pre- and postoperative visual acuity. The mean observation period was 24 months. Discussion. L-P-KP offers a new surgical opportunity in the treatment of high-risk cases of limbal deficiency.