Barcelona-Cincinnati technique for limbal transplantation

Resumen

PURPOSE: To describe a new technique of allogenic limbal transplantation for total 28 limbal stem cell de!ciencies (LSCD). METHODS: "e “Barcelona-Cincinnati” technique combines a cadaveric keratolimbal allograft and transplantation of ex vivo expanded limbal cells on amniotic membrane (AM). A 1 x 3-mm biopsy of limbal tissue was obtained from a living donor for ex vivo culture on AM for 2-3 weeks. Two 120° corneoscleral rims were obtained from the cadaveric donor. A 360° limbal peritomy was performed on the recipient eye, and the cadaveric crescents were sutured on the superior and inferior limbus. Abnormal !brovascular pannus and epithelium were removed from the surface of the cornea and peripheral areas. A penetrating keratoplasty was then performed. Finally, AM with ex vivo expanded limbal cells was sutured over the cornea epithelial-side down. Postoperatively, topical steroids and systemic immunosuppression with methylprednisolone and cyclosporine A were prescribed and, in the absence of an immunological reaction, tapered o#. RESULTS: Two eyes of two patients with bilateral total LSCD were treated. Six years postoperatively, Case 1 maintained a stable ocular surface. Case 2, however, presented recurrence of LSCD 17 months after surgery. CONCLUSION: Although prospective comparative studies including more patients and a longer follow-up are required, the Barcelona-Cincinnati technique may be an e#ective alternative for bilateral total LSCD while decreasing the risk for living donors.