Decellularized Descemet Membrane Anterior Keratoplasty With Allogeneic Simple Limbal Epithelial Transplantation for Partial Limbal Stem Cell Deficiency Following Partial Keratolimbal Allograft Failure

Albert Y Cheung; Cameron B Reinisch; Joshua H Hou

doi:10.1097/ICO.0000000000003565

Decellularized Descemet Membrane Anterior Keratoplasty With Allogeneic Simple Limbal Epithelial Transplantation for Partial Limbal Stem Cell Deficiency Following Partial Keratolimbal Allograft Failure

Cornea. 2024 May 3. doi: 10.1097/ICO.0000000000003565. Online ahead of print.

Authors

Albert Y Cheung^{1

2}, Cameron B Reinisch³, Joshua H Hou⁴

Affiliations

¹ Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA.
² Virginia Eye Consultants, Norfolk, VA.
³ University of Cincinnati School of Medicine, Cincinnati, OH; and.
⁴ Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN.

PMID: 38713471
DOI: 10.1097/ICO.0000000000003565

Abstract

Purpose: The purpose of this study was to describe the use of Descemet membrane anterior keratoplasty (DMAK) with modified allogeneic simple limbal epithelial transplantation to treat a case of partial limbal stem cell deficiency (LSCD) following keratolimbal allograft failure.

Methods: Case report.

Results: A 21-year-old woman with autoimmune polyglandular syndrome-related LSCD presented with pain and decreased vision. There was partial failure and recurrence of LSCD after a severe/acute keratolimbal allograft rejection that led to persistent epithelial defects refractory to conservative therapy. This was treated with a superficial keratectomy and placement of a DMAK. A modified allogeneic simple limbal epithelial transplantation was performed with an overlying amniotic membrane and temporary tarsorrhaphy. There was epithelialization of the corneal surface by 3 to 4 weeks with an improved ocular surface. Despite partial recurrence of late staining, the cornea has remained epithelized, vision has improved, and the patient has remained pain-free more than 1.5 years following the procedure.

Conclusions: DMAK may be a long-term substrate to help improve and maintain epithelization of the cornea up to 1.5 years. DMAK may be a viable alternative to using amniotic membrane as a scaffold in allogeneic simple limbal epithelial transplantation for treatment of partial LSCD. While late epithelial staining recurred in our patient, DMAK appears to prevent recurrent epithelial defects and reduce ocular surface pain, conveying an improvement in quality of life in patients at high risk of rejection/failure.