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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.
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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.

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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).

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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).

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