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cases, or from allogenic origin (from cadaver donor or living relative or
non-relative donor) in bilateral disease (Dua et al. 2010). The piece of limbal
tissue is subsequently cultivated and expanded on amniotic membrane
in vitro always according to the guidelines for good manufacturing practice
(GMP) (Bosse et al. 1997), with strictly regulated procedures and high
quality control tests to manipulate stem cells as “medicinal products”.
The transplantation is performed on the denuded corneal surface at the
disordered eye, after superfi cial keratectomy to remove fi brovascular
ingrowth ( Fig. 3 ). This procedure improves the ocular surface condition, but
in many cases an additional corneal graft is needed for visual rehabilitation.
The cost and technical diffi culties currently limit the availability of this
Figure 3 This fi gure shows the ex vivo expanded limbal graft carried in amniotic membrane
covered by a great diameter therapeutic contact lens.
Color image of this figure appears in the color plate section at the end of the topic.
After ocular surface stabilization, consideration of a subsequent keratoplasty
can be entertained. Different options can be performed. Signifi cant stromal
scarring with good endothelial function allows an anterior lamellar
A posterior lamellar transplantation is possible after endothelial failure
with a preserved normal stroma. In patients with stromal and endothelial
disease, penetrating keratoplasty is required for visual rehabilitation. Finally,
some special conditions demand keratoprosthesis as the last solution.
Penetrating Keratoplasty
Penetrating keratoplasty (PK) has been the surgical treatment of choice
for visual rehabilitation in corneal disease. PK involves full-thickness
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