Key Concepts A multidisciplinary approach is necessary for ocular surface reconstruction. Optimizing the ocular surface is vital prior to performing keratoplasty. Two-stage approach is preferred over simultaneous ocular surface reconstruction and keratoplasty. Systemic immunosuppression is generally well tolerated and safe.…
Key Concepts The postoperative care of the limbal transplant patient is perhaps the most critical part of the care. Problems such as persistent inflammation or epitheliopathy should be addressed early by increasing immunosuppression or using adjunctive measures such as punctal…
Key Concepts Keratolimbal allograft (KLAL) is a surgical treatment for limbal stem cell deficiency where deceased donor tissue is used. Systemic immunosuppression is required to prevent rejection of the highly immunogenic vascularized limbal donor tissue. Structural lid abnormalities, glaucoma, and…
Key Concepts Living-related conjunctival limbal allograft (LR-CLAL) transfers fresh allogenic limbal and conjunctival (with goblet cells) tissue from a matched living relative for treatment of symptomatic partial or total limbal stem cell deficiency (LSCD). Proper donor selection maximizes the success…
Key Concepts Conjunctival limbal autograft (CLAU) represents the first surgical option for unilateral limbal stem cell deficiency, given the good long-term survival results and visual outcomes. The most important risk factors contributing to graft failure are severe dry eye, chronic…
Key Concepts Renewal of the corneal epithelium results from limbal epithelial stem cells (LESCs) located at the basal layer of epithelium found at the corneoscleral limbus. The limbal stem cell niche has a crucial impact on LESC function and regulation.…
Key Concepts Cornea transplantation has made tremendous progress over the last decade, but major problems still exist: worldwide blindness, immune rejection, and severe ocular surface disease. An artificial cornea is needed due to major deficiencies in current eye banking and…
Key Concepts The keratoprosthesis (KPro) may have expanded indications, but there remain many difficulties in its postoperative management. The KPro is not ideal for patients with severe ocular surface disease, such as Stevens-Johnson syndrome, mucous membrane pemphigoid, and severe chemical…
Key Concepts While early studies found conflicting results, most recent studies have concluded better visual acuity outcomes with thinner Descemet stripping automated endothelial keratoplasty (DSAEK) tissue. With a newer preparation technique to produce DSAEK grafts with thickness ≤50 μm, we…
Key Concepts The development of contemporary corneal transplantation has been evolutionary and largely evidence-based over the past century. The first successful, documented corneal graft was reported in 1906. Ramon Castroviejo is recognized as the pioneer of modern keratoplasty, and R.…