Donor site complications in autolimbal and living-related allolimbal transplantation

Ophthalmology. 2011 Jul;118(7):1265-71. doi: 10.1016/j.ophtha.2010.11.030. Epub 2011 Mar 31.


Objective: To study the long-term changes at donor sites and safety implications for donor eyes used for harvesting tissue for autologous and living-related donor limbal transplants.

Design: Retrospective, observational, consecutive case series.

Participants: We examined 50 donor sites of limbal tissue belonging to 25 healthy eyes (23 human subjects).

Methods: The corneas and limbus of donor eyes were assessed for symptoms and visual acuity and examined by slit-lamp biomicroscopy and in vivo confocal microscopy with particular emphasis on the donor sites and central cornea.

Main outcome measures: In the donor eyes, we assessed visual acuity, persistence of symptoms, stability of the corneal epithelium, and the clinical and microscopic changes that occurred at the donor sites.

Results: Mean follow-up was 41±38 months (median, 24; range, 3-127). All eyes had symptoms of ocular discomfort up to 4 weeks postoperatively and remained asymptomatic thereafter. No patient reported subjective reduction in visual acuity. Mean best-corrected visual acuity (logarithm of the minimum angle of resolution fraction) preoperatively was 0.076±0.19 and postoperatively was 0.09±0.17 (P = 0.57). All donor sites showed re-epithelialization of the peripheral denuded limbus within 2 weeks. Observed complications were filamentary keratitis and subconjunctival hemorrhage in 4 eyes. In vivo confocal microscopy confirmed that the central corneal epithelium remained normal in all eyes. The re-epithelialized donor site was covered with conjunctival epithelium in 17 sites of 10 eyes and with corneal epithelium in 7 sites of 5 eyes.

Conclusions: Limbal donation of 2 clock-hours of the superior and inferior limbus with 3×3 mm of adjacent conjunctiva was a safe procedure in this group of patients, demonstrating stable vision and an intact corneal epithelium during the follow up period. Donor sites can be re-epithelized by multiple layers of either corneal or conjunctival epithelium and is associated with deep stromal scarring.

MeSH terms

  • Adult
  • Aged
  • Cicatrix / etiology
  • Conjunctiva / blood supply
  • Corneal Stroma / pathology
  • Corneal Transplantation*
  • Epithelium, Corneal / pathology
  • Eyeglasses
  • Female
  • Follow-Up Studies
  • Hemorrhage / etiology
  • Humans
  • Keratitis / etiology
  • Limbus Corneae*
  • Living Donors*
  • Male
  • Microscopy, Confocal
  • Middle Aged
  • Pain / etiology
  • Retrospective Studies
  • Time Factors
  • Tissue and Organ Harvesting / adverse effects*
  • Transplantation, Autologous
  • Visual Acuity
  • Young Adult