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Combined Conjunctival Limbal Autografts and Living-Related Conjunctival Limbal Allografts for Severe Unilateral Ocular Surface Failure

Cheung, Albert Y. MD*,†; Sarnicola, Enrica MD*,‡; Govil, Amit MD§; Holland, Edward J. MD*,†

doi: 10.1097/ICO.0000000000001376

Purpose: To describe the technique and present 2 cases of a combined conjunctival limbal autograft (CLAU) and living-related conjunctival limbal allograft (lr-CLAL) procedure for treatment of severe unilateral ocular surface failure.

Methods: Interventional case series of 2 eyes of 2 patients sustaining severe thermal/chemical injuries from firework explosions. They both underwent the combined CLAU/lr-CLAL procedure followed by penetrating keratoplasty. Systemic immunosuppression consisted of oral tacrolimus and mycophenolate mofetil.

Results: Preoperative vision was counting fingers for both patients, whereas visual acuity at last follow-up ranged between 20/40 and 20/50. Both patients maintained a stable surface at last follow-up without any episodes of rejection. Patients tolerated systemic immunosuppression well without any persistent adverse reactions.

Conclusions: Certain etiologies of limbal stem cell deficiency also lead to significant conjunctival (and goblet cell) deficiency. Combined CLAU and lr-CLAL procedures maximize the amount of healthy limbal stem cells with conjunctiva while also minimizing the antigenic burden as all transplanted tissue potentially can be a complete (or near-complete), compatible HLA and crossmatch.

*Cincinnati Eye Institute, Cincinnati, OH;

Department of Ophthalmology, University of Cincinnati, Cincinnati, OH;

Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy; and

§Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, OH.

Reprints: Edward J. Holland, MD, Cincinnati Eye Institute, 580 South Loop Rd, Suite 200 Edgewood, KY 41017 (e-mail:

E. J. Holland has consulted for Alcon Laboratories, Allergan, Bausch & Lomb, Kala Pharmaceuticals, Mati Pharmaceuticals, Omeros, PRN, Senju Pharmaceuticals, Shire, TearLab, and TearScience. The remaining authors have no funding or conflicts of interest to disclose.

Received May 24, 2017

Received in revised form July 14, 2017

Accepted July 28, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.