Penetrating Keratoplasty in Ocular Stem Cell Disease

Certain conclusions appear to be clear regardless of the planned surgical approach. The risk of graft rejection and/or recurrent surface disease is higher whenever penetrating keratoplasty is performed in the context of stem cell dysfunction and after a stem cell transplant. In both approaches, the risk of corneal graft rejection is higher than in the keratoplasty population in general. This mandates special considerations in the management of recipient immunosuppression and management of the ocular surface. Finally, larger studies with considerably longer follow-up will be necessary before the ideal surgical and adjunct medical regimens can be determined. It is clear that penetrating keratoplasty plays a significant role in the visual rehabilitative stage of stem cell transplantation. When corneal grafting is necessary after stem cell transplantation, meticulous attention must be paid to nurturing the ocular surface, and to immunosuppression, for the prevention of graft rejection.