We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Case Report/Case Series |

Immunological Rejection Following Allogeneic Cultivated Limbal Epithelial Transplantation

Yoshiyuki Satake, MD, PhD1; Murat Dogru, MD, PhD1; Takefumi Yamaguchi, MD1; Daisuke Tomida, MD, PhD1; Masatoshi Hirayama, MD2; Jun Shimazaki, MD, PhD1,2
[+] Author Affiliations
1Department of Ophthalmology, Tokyo Dental College, Chiba, Tokyo, Japan
2Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
JAMA Ophthalmol. 2013;131(7):920-922. doi:10.1001/jamaophthalmol.2013.15.
Text Size: A A A
Published online


Allogeneic cultivated limbal epithelial transplantation (CLET), including living-related CLET, is recommended for bilateral cases with limbal stem cell deficiency or for unilateral cases in which the patient wishes to preserve the limbal function of the healthy fellow eye. For a long-term successful corneal epithelial restoration, it is important to maintain a suitable ocular surface environment and to prevent allograft rejection. Previous reports13 on allogeneic CLET have indicated only the incidence of allograft rejection, with no information on the clinical course or on anterior segment findings. We previously examined 13 patients who underwent allogeneic CLET without any episodes of allograft rejection.2 The details of the epithelial sheet preparation and CLET procedures have also been outlined previously.4 Thereafter, we performed 37 allogeneic CLET procedures in 31 eyes and experienced 3 rejection episodes in 2 eyes with characteristic clinical manifestations. Herein, we describe 2 cases who developed clinically significant allograft rejection reactions.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.
Preoperative Photographs of the Right Eye of a 26-Year-Old Man

Preoperative photographs of the right eye of a 26-year-old man who complained of blurred vision and ocular pain and was admitted to the hospital with a total corneal epithelial defect and necrosis of the bulbar conjunctival tissue caused by fireworks (case 1). The photographs show the eye before the transplant (A), with conjunctival injection and edema at the limbal host-graft junction (B), a 360° linear epithelial defect during the rejection episode (C), and reduction of inflammation after intensive treatment (D).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Preoperative Photographs of an 11-Year-Old Boy

Preoperative photographs of an 11-year-old boy who presented with metal particles in the right corneal stroma and refractory epithelial defects on the keratoconjunctival surface following an accidental acid injury (case 2). The photographs show the acidic metal particles embedded in the corneal stroma and the necrotic conjunctival tissues (A), the central linear epithelial rejection line with slight ocular surface inflammation (B and C), and the development of a geographical pattern progressing centrally and the late staining above the rejection line suggesting instability of the conjunctival epithelium (D and E).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

2 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections