Sir,

Zaidi et al1 infer that the corneal donor epithelial defect noted day 1 postkeratoplasty is secondary to limbal stem cell deficiency. How can this be so? A donor epithelial defect day 1 is surely due solely to loss of donor epithelium and has nothing to do with host limbal stem cell function. They have treated the donor epithelial defect with cyclosporin drops and intensive topical preservative-free steroids. This is inappropriate management for both stem cell dysfunction and persistent donor epithelial defect. They have then performed a limbal stem cell graft along with repeat keratoplasty, used the same inappropriate line of clinical management and observed a similar but less severe course of events. Therefore, they have neither demonstrated that limbal stem cell deficiency was the cause of the problem nor shown any convincing benefit from the stem cell graft.