Corneal epithelial restoration after penetrating keratoplasty in repeated failed cultivated limbal stem cell grafts

To report a case of corneal epithelial restoration after penetrating keratoplasty following multiple complications in repeated failed cultivated stem cell grafts. This is a case report of a 62-year old patient who was treated for unilateral severe limbal stem cell deficiency after a chemical burn of the right eye. Two attempts to reconstruct the ocular surface using autologous cultivated limbal stem cell grafts (CLET) failed, and were complicated by perforations requiring two emergency penetrating keratoplasties. While the first donor cornea revascularised quickly, the corneal epithelium of the second remained transparent, avascular and stable until one year postoperatively. In vivo confocal microscopic examination confirmed presence of a healthy corneal epithelial phenotype. Occurrence of serious adverse events are related to an inadequate epithelial homeostasis following CLET. The mechanisms of action of limbal stem cell transplantation are still poorly understood and the corneal epithelial integrity may be maintained without limbal input.