Femtosecond Laser-Assisted Keratolimbal Allograft Transplantation for the Treatment of Total Limbal Stem Cell Deficiency

Abstract

Purpose: To investigate the surgical procedure and therapeutic efficacy of femtosecond (FS) laser-assisted keratolimbal allograft (KLAL) transplantation in the treatment of eyes with total limbal stem cell deficiency. Methods: Ten eyes from 10 patients who underwent FS laser-assisted KLAL transplantation were enrolled. The best-corrected visual acuity (BCVA), ocular surface stability, corneal transparency, and postoperative complications were recorded. Results: The keratolimbal grafts prepared using the FS laser were even in thickness and width. After the surgery, glucocorticoid and tacrolimus eye drops were administered locally to the eyes with concentration gradients, and a medium dose was prescribed for maintenance. Within the mean follow-up period of 16.8 ± 7.3 months, 9 of 10 eyes (90.0%) maintained a stable ocular surface and showed significant improvements in corneal transparency and BCVA. Persistent corneal edema only occurred in one eye because of repeated epithelial defects, and the BCVA of this eye did not improve. Confocal microscopy revealed activated dendritic cells in the Bowman membrane at the limbus, but they were always low in density with small dendritic processes. No acute immune rejection, cataracts, or elevation of intraocular pressure were detected. Conclusions: The FS laser-assisted KLAL technique can produce ring-shaped grafts with an even depth and width, resulting in a stable ocular surface and good visual prognosis. After surgery, glucocorticoids and potent immunosuppressive eye drops were administered locally with concentration gradients and effectively inhibited acute immune rejection.

The outcomes of corneal sight rehabilitating surgery in Stevens-Johnson syndrome: case series

“…Harvesting enough limbal stem cell tissue from living-related donors is very difficult. Moreover, the outcome of living-related LSCT has been reported to be unsatisfactory in such eyes [ 33 – 35 ]. Therefore, all LSCT performed in our study were cadaveric KLAL.…”

Indications and Surgical Techniques for Repeat Corneal Transplantation in Eastern China: A Twelve-Year Study

“…As a result of technical limitations, allogeneic KLAL has been the only method of limbal stem cell transplantation used in eastern China in the past 12 years. Nevertheless, many reports have confirmed that immunosuppressive treatments are usually needed to help to maintain a stable ocular surface after KLAL, and repeat or even multiple KLAL are often required in severe cases of LSCD [ 34 , 35 ]. The clinical application of cultivated epithelial transplantation and simple limbal epithelial transplantation provides more options for patients with chemical burns to reconstruct a stable ocular surface.…”

Topical administration of tacrolimus and corticosteroids in tapering doses is effective in preventing immune rejection in high-risk keratoplasty: a 5-year follow-up study

“…Subsequently, 0.1% fluorometholone was administered 4 times daily for 6 months and then, it was replaced by 0.02% fluorometholone, which was used three times a day for at least 1 year. The combination of tobramycin and dexamethasone ophthalmic ointment was applied every night for 6 months and then the frequency was tapered to twice weekly [ 13 – 16 ]. In addition, the patients were instructed to use 0.1% tacrolimus eye drops or 1% CsA eye drops 4 times a day for 1 month and then, the frequency was tapered to three times per day for 6 months and twice daily for at least 1 year (Fig.…”