Epithelial rejection and reversal of rejection in a case of allo-simple limbal epithelial transplant (SLET)

A 25-year-old male presented with bilateral limbal stem cell deficiency (LSCD). He underwent an allogenic limbal stem cell transplant, as an autologous limbal source was not available for stem cell transplantation. One has to depend on systemic immunosuppression in case of an allogenic source, such as living-related or non-related donors or cadaveric limbal tissue usage. Our patient, too, was on systemic immunosuppression in the form of tablet azathioprine. On stopping immunosuppression on his own, he presented with epithelial rejection. Signs of rejection like elevated epithelial ridge, immune infiltrates around transplants, ingrowth of perilimbal vessels toward limbal transplants, and decreased vision were noted and subsequently reversed with the restarting of systemic immunosuppression.