The surgical outcomes of limbal allograft transplantation in eyes having limbal stem cell deficiency

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Özer M. D., Altinkurt E., Yilmaz Y. C., Gedik A. C., Alparslan N.

Journal of Current Ophthalmology, vol.32, pp.132-141, 2020 (ESCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 32
  • Publication Date: 2020
  • Doi Number: 10.4103/joco.joco_91_20
  • Journal Name: Journal of Current Ophthalmology
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus
  • Page Numbers: pp.132-141
  • Istanbul University Affiliated: Yes

Abstract

Purpose: To report the limbal allograft transplantation and penetrating keratoplasty (PK) results in limbal stem cell deficiency (LSCD)‑developed

eyes because of chemical or thermal injury.

Methods: Medical records of 18 eyes of 14 patients who had undergone keratolimbal allograft (KLAL) or living‑related conjunctival limbal

allograft (lr‑CLAL) with or without PK and followed up at least 1 year postoperatively were evaluated retrospectively. The preoperative LSCD

grade was noted in all patients. Rejection incidents, recurrence of LSCD, and corneal graft clarity along with a visual improvement during

the follow‑up were noted. The complications rate due to surgery or injury itself, for instance, glaucoma and cataract, were evaluated. The

limbal allograft tissue survival analysis and corneal allograft survival analysis were done to reveal the differences in both the procedures. The

existence of normal corneal epithelium and improvement in visual acuity were accepted as the surgical success criteria.

Results: In the limbal allograft transplantation group, the survival rates of the allograft tissue were 65 ± 10.7% at 1 year and 36.6 ± 11.4% at

3 years in lr‑CLAL and 66.7 ± 15.7% at 12 months and 53.3 ± 17.3% at 18 months in KLAL‑transplanted eyes. The survival rate of corneal

allograft at the 5th postoperative year was lower in the simultaneous procedure compared to the staged procedure, but it was not statistically

significant (25.7 ± 25.8% vs. 62.5 ± 17.1%, P = 0.75). The ambulatory vision was achieved in 10 eyes (56%) after a mean follow‑up time of

93.8 ± 37.8 months. The visual acuity level has increased in 12 eyes (67%) in which the limbal allograft transplantation was applied. The ambulatory

visual acuity level was achieved (≤1.0 logMar [20/200]) in 10 eyes (56%). In addition, two or more Snellen lines’ gain in the best corrected visual

acuity was observed in 12 eyes of 18 (67%) at the last follow‑up, and there was not any significant difference between the KLAL and lr‑CLAL.

Conclusions: Ocular surface integrity was longer in KLAL than in lr‑CLAL transplantation, but it was not statistically significant. The

staged procedure was more convenient than the simultaneous procedure in terms of corneal allograft clarity maintenance in limbal

allograft‑employed eyes.