Homologous penetrating central limbokeratoplasty in granular and lattice corneal dystrophy

Purpose. Subepithelial recurrences in the graft are well known after conventional penetrating keratoplasties in granular and lattice dystrophies. In contrast to what is still written in most textbooks, both dystrophies have their origin in the epithelium, which originates from the Limbal stem cells. The aim of this study, therefore, is to investigate whether recurrences can be avoided or minimized by simultaneous transplantation of healthy donor limbus by means of a homologous central limbokeratoplasty. Methods. Since October 1995, five patients with granular and four patients with lattice dystrophies were treated with homologous penetrating central limbokeratoplasties. Approximately 40% of the graft's circumference contained limbal donor stem cells. After surgery, cyclosporin A was administered for at least 6 months to protect the limbal stem cells from immunologic destruction. Results. During a follow-up period of 12-35 months, one recurrence was observed, probably because of an immune reaction against the transplanted limbal stem cells after tapering off the immune prophylaxis. Conclusion. These first results are in agreement with our expectations. More patients, however, must be operated on in this way. Follow-up must occur for many years before we will definitely know under which conditions long-term survival of donor stem cells occurs to such an extent that subepithelial recurrences in granular and lattice dystrophies stop being a major problem after keratoplasty in these patients.