Long-term outcomes of donor eyes after conjunctival limbal autograft and allograft harvesting

Objective: To investigate the ocular surface stability of donor eyes after conjunctival limbal autograft (CLAU) or conjunctival limbal allograft (CLAL). Design: Retrospective interventional case series. Participants: Patients diagnosed with limbal stem cell deficiency (LSCD) who underwent ocular surface stem cell transplantation with postoperative follow-up of at least 3 months. Methods: Donor eye data collected included preoperative and postoperative Snellen best-corrected visual acuity (BCVA), intraoperative and postoperative complications, re-epithelialization times, and ocular surface stability at the last follow-up. Results: Sixteen donor eyes of 16 patients were included, the mean age at the time of surgery was 59.3 years, and the mean follow-up period was 53 months. The most common injury etiology was chemical injury, followed by iatrogenic causes and Stevens-Johnson syndrome, then congenital aniridia. Eleven patients underwent CLAU, 3 underwent living-related CLAL, and 2 underwent CLAL combined with keratolimbal allograft. Preoperative mean donor eye BCVA was 0.22 ± 0.32 logMAR (Snellen equivalent ≈ 20/33), and mean BCVA at the last follow-up was 0.18 ± 0.24 logMAR (Snellen equivalent ≈ 20/30) (p = 0.4). All donor eyes had a stable ocular surface at the last follow-up, with no signs of iatrogenic LSCD or delayed corneal epithelial healing. There were no intraoperative or postoperative complications such as infections, persistent epithelial defects, corneal neovascularization, or chronic inflammation. Conclusion: This study provides additional evidence for the long-term safety of donor eyes when providing limbal stem cell tissue for CLAU or CLAL.