CLINICAL SCIENCE Cornea Society Nomenclature for Ocular Surface Rehabilitative Procedures Sheraz M. Daya, MD, FACP, FACS,* Clara C. Chan, MD, FRCSC,†‡ and Edward J. Holland, MD,†‡ On Behalf of the Members of The Cornea Society Ocular Surface Procedures Nomenclature Committee Purpose: In the past 20 years, there has been tremendous development in ocular surface rehabilitation and, through better understanding and improvements in analytic and culture techniques, a variety of new procedures have been developed. Differing techniques have been used internationally and often similar terminology is used when procedures could be considered to be quite different or vice versa. To communicate clearly and to compare techniques and outcomes, it was determined that an agreed international nomenclature was necessary. Methods: A subcommittee was established by The Cornea Society. An initial steering group of international experts with special interest in ocular surface was assembled and established broad principles for the nomenclature based on a previous nomenclature. Results: The nomenclature for procedures was based on several parameters, including a) anatomic source of tissue transplanted, for example conjunctival, keratolimbal or mucosal, b) whether the source was autologous or allogeneic (cadaveric or living related), and c) cell culture techniques. For example, an expanded cell culture of cadaveric limbal tissue was named ex-vivo cultivated cadaveric limbal allograft (EvC-LAL). Conclusions: Agreed nomenclature for transplantation procedures used in ocular surface rehabilitation has been developed, and use of this common terminology should help communication among those involved in this field. Key Words: ocular surface disease, ocular surface reconstruction, stem cell deficiency, stem cell transplantation, tissue engineering, cultured cells, limbal stem cell (Cornea 2011;00:000–000) T he ocular surface of the eye is a functional unit consisting of the eyelids, lubrication, conjunctiva, and cornea. The homeostasis of the ocular surface is vital for the maintenance of good corneal epithelium, which is vital for corneal clarity and vision. The eyelids are important not only for complete closure and protection but also for the wiper action they provide during blinking to pick up tears from the lower eyelid meniscus for distribution across the corneal surface. Lubri- cation is important in terms of content, osmolality, and quantity. 1 Normal conjunctiva provides mucins from goblet cells, along with cytokines. The corneal limbus has been recognized and accepted as the source of limbal stem cells for the replacement of normal corneal phenotype. 2–4 Through better understanding and improved analytical techniques, ocular surface rehabilitation has made tremendous strides benefiting patients enormously in the past 2 decades. Rehabilitation of the ocular surface includes improving the ocular surface environment. This entails ensuring good control of inflammation, good lubrication, adequate eyelid closure, and elimination of keratinization and symblephara. Restora- tion of normal corneal phenotype and, in turn, corneal clarity is highly dependent on a good environment. A number of transplantation techniques have been used over the years, and many have been described using various terminology, including autologous and allograft conjunctival transplanta- tion, 5–7 keratoepithelioplasty, 8 homotransplantation of limbal cells, 9 limbal transplantation, 10 and autologous 11 and allograft limbal transplantation. 12–15 These terms are not always clear in terms of tissue source (autogeneic or allogeneic) and precise anatomic location. Limbal transplantation, for instance, can involve the conjunctiva alone or both corneal and scleral tissue. 16 Additionally, in the past 15 years, tissue engineering techniques have been developed that have involved the culture and expansion of presumed stem cells with transplantation back to the host or to another recipient. 17–27 Clarity of communication and the ability to accurately compare the outcomes of these innovative procedures are necessary. Holland and Schwartz, 16 recognizing the need for common terminology, provided a rationale for common nomenclature illustrating a variety of techniques described in the literature, often using similar terminology. The authors proposed a classification based on anatomic source of the tissue and genetic source (autologous, allogeneic, and living- related). The terminology and abbreviations used are now commonplace. Since 1996, however, more techniques have been described, including new sources of tissue 28–35 and the Received for publication October 28, 2010; revision received November 10, 2010; accepted November 12, 2010. From the *Corneoplastic Unit & Eye Bank, Queen Victoria Hospital, East Grinstead, West Sussex, United Kingdom; †Cincinnati Eye Institute, Cincinnati, OH; and ‡University of Cincinnati, Cincinnati, OH. Members of the Cornea Society Ocular Surface Procedures Nomenclature Committee is listed in Appendix 1. Reprints: Sheraz M. Daya, Centre for Sight, Hazelden Place, East Grinstead, West Sussex, RH19 4RH United Kingdom (e-mail: sdaya@centreforsight.com). Copyright Ó 2011 by Lippincott Williams & Wilkins Cornea  Volume 00, Number 0, Month 2011 www.corneajrnl.com | 1