Sclerocorneal limbus transplantation

Purpose Discussion of the evolution of a technique suggested by José I. Barraquer in 1947, later completed by Strampelli and adopted and modified by other corneal surgeons. The original procedure was based on the clinical observation that regeneration of the corneal epithelial cells is dependant on the state of the limbus. This explained the bad prognosis of chemical burns and severe limbus trauma. At present it is well known that the stem cells located in the corneal limbus are responsible for epithelial regeneration. Penetrating keratoplasty limited to the cornea does not supply stem cells. Methods The technique consists in obtaining and grafting limbus tissue, in form of an annular or partial conjunctivosclerocorneal limbal graft preferably from the fellow eye or a living donor, or an eye bank eye. A case of chemical burn operated in 1981 is presented to illustrate the original technique of Strampelli. To illustrate the modern approach a case of chemical trauma with superior and inferior symblepharon and total vascularized leucoma operated in 1999 (limbal donor graft)taking advantage of the modern advances available at present (improved instrumentation, pharmacological inhibition of homograft reaction)is shown. Results The results were encouraging.The patient operated in 1981 died in 1988 with good vision (0.6).In the case operated in 1999, three months after the limbal transplant, re‐epithelization of the cornea was correct and an 8 mm penetrating keratoplasty combined with cataract extraction and IOL implantation was performed. Corrected vision 5 years postoperatively was 0.35. Conclusion Modern investigation and technology have converted a procedure based on surgical inspiration more than half a century ago into a valuable option in cases of irreversible damage of the corneal limbus.