JAN 13, 2009
Cornea/External Disease
This article describes a novel technique using cyanoacrylate glue to dissect corneal limbal tissue and harvest limbal stem cell allografts from organ culture media-stored corneoscleral buttons without artificial anterior chambers. The authors report that the procedure is safe and easy to perform. They have used it to obtain grafts implanted in four patients with limbal stem cell deficiency who also underwent penetrating keratoplasty.
While dissection of limbal tissue to obtain stem cells from whole globes is relatively easy, whole globes are usually not available for limbal tissue transplantation, according to the authors. Corneal limbal tissue can be used instead, but dissecting limbal tissue from an unstable corneoscleral button can be technically demanding. The authors, therefore, developed a new technique for obtaining stem cells.
They divided a donor corneoscleral button left over from penetrating keratoplasty into two semicircular halves. They attached one of them epithelial side up to a sterile rubber block with tissue adhesive N-butyl-2-cyanocrylate. This provided the stability necessary for lamellar dissection of the limbal tissue up to 80 percent of full thickness depth without damaging the limbal epithelium.
Of the four patients for whom this technique was used, two had ocular cicatricial pemphigoid, one had ocular chemical burns and one had Stevens-Johnson syndrome. All of them maintained clear corneal grafts through 18 months of follow-up. There was no histological evidence of glue or cellular toxicity in the limbal stem cells harvested for these patients.