JUL 18, 2011
Cornea/External Disease
The literature on donor site complications in eyes used for harvesting tissue for limbal autografts and allografts is sparse, with either no complications or only minor effects reported. Such complications can range from minor transient irritation to potential infection and decompensation of the donor corneal epithelium.
In this retrospective case series, researchers evaluated 50 limbal tissue donor sites belonging to 25 healthy eyes used for harvesting tissue for auto- and living-related donor limbal transplants. Subjects were followed for a median of 24 months.
While all patients experienced discomfort up to four weeks following surgery, they were asymptomatic thereafter, with no subjective reduction in visual acuity. All donor sites demonstrated re-epithelialization of the peripheral denuded limbus within two weeks, and in vivo confocal microscopy confirmed that the central corneal epithelium remained normal in all eyes. Re-epithelialization of donor sites occurred with multiple layers of either corneal or conjunctival epithelium and was associated with deep stromal scarring. Complications were minor and included filamentary keratitis, negative staining with fluorescein, and subconjunctival hemorrhage; all resolved without any lasting consequences or visible effects.
Although the exact amount of donor limbus that can be safely removed is unknown, the authors found that removal of one third of the donor limbus in the form of two pieces of two clock-hours each (a total of 120°) from the superior and inferior limbus was sufficient and yielded adequate epithelial growth onto the recipient cornea stroma.
The authors conclude that minor donor site complications can occur immediately postoperatively, but long-term consequences seem unlikely. Nevertheless, the potential risk of donor site infection and decompensation of donor corneal epithelium must be considered in all cases.