Decellularized Descemet Membrane Anterior Keratoplasty as a Basement Membrane Scaffold for Ocular Surface Reconstruction: Two Cases of Limbal Stem Cell Deficiency

PURPOSE: To describe clinical outcomes of decellularized Descemet membrane anterior keratoplasty (DMAK) as a basement membrane scaffold for ocular surface reconstruction in limbal stem cell deficiency (LSCD). METHODS: Interventional case series. RESULTS: Case 1: A 66-year-old man with ocular cicatricial pemphigoid-like keratoconjunctivitis presented with bilateral total LSCD (Stage III) and visually significant cataracts. Best-corrected visual acuity was 0.01 (decimal) in both eyes. Sequential DMAK combined with phacoemulsification and intraocular lens implantation was performed without adjunctive epithelial stem cell transplantation. Supplemental amniotic membrane transplantation was required in the left eye at 3 weeks postoperatively. Complete epithelialization was achieved within approximately 8 weeks in both eyes. The ocular surface remained stable during follow-up, with no significant complications. CASE: A 70-year-old man with postsurgical partial LSCD (Stage II) in the left eye following tube-shunt glaucoma surgery underwent autologous limbal transplantation using the blind right eye as the limbal tissue donor, combined with simultaneous DMAK. Complete epithelialization was achieved, and a stable ocular surface was maintained throughout follow-up. CONCLUSIONS: DMAK may serve as a biologically compatible and optically transparent basement membrane scaffold that facilitates epithelial regeneration and ocular surface stabilization in advanced and postsurgical LSCD.