Outcome of keratolimbal allograft transplantation with deep anterior lamellar keratoplasty for bilateral limbal stem cell deficiency

Abstract

ObjectivesTo evaluate and compare the outcome of keratolimbal allograft (KLAL) transplantation with or without deep anterior lamellar keratoplasty (DALK) for bilateral severe limbal stem cell deficiency (LSCD).MethodsThis retrospective review included 49 eyes of 46 patients who underwent KLAL transplantation at the Department of Ophthalmology of Chinese PLA general hospital, 2009–2020, for bilateral severe LSCD were examined for corneal clarity and corneal scarring to determine whether to combine DALK with KLAL transplantation. Preoperative information, surgical decision tree, surgical procedures, and postoperative data were collected for each eye.ResultsAll patients had preoperative severe or total LSCD. Twenty-four eyes underwent KLAL transplantation only, 25 KLAL transplantation plus DALK. The mean follow-up was 46.80 ± 31.22 months (18–158 months). Overall KLAL survival (with or without DALK) was 71.43% at the final follow-up (KLAL-only 66.67%, KLAL-DALK 76%). Kaplan–Meier survival analysis showed that the 3-year survival probability of all grafts was 70.53 ± 10.89% (KLAL-only 64.86 ± 10.11%, KLAL-DALK 75.79 ± 8.62%). The proportion of BCVA ≥ 20/200 eyes among all KLAL transplantations increased from 11 eyes (22.45%) preoperatively to 25 eyes (51.02%) after 1 year and 24 eyes (48.98%) at the last follow-up (P = 0.01). The proportion of BCVA ≥ 20/200 eyes in the KLAL-DALK group increased significantly (P = 0.04), from 16.0% at baseline to 48.0% after 1 year to 44.0% at the last follow-up. Seventeen eyes (34.69%) had postoperative complications.ConclusionKLAL-DALK is an effective option to restore a stable ocular surface and visual acuity rapidly in patients with bilateral, late-stage, severe LSCD.

Recent advances in cell-based regenerative therapies for corneal disease

“…Interestingly, Prabhasawat et al [10 ▪ ] found no difference when comparing autologous and living-related allogeneic SLET survival, even when combined with PKP. Similarly, when Li et al [11 ▪ ] compared KLAL alone against combined surgery with deep anterior lamellar keratoplasty (DALK) in 49 eyes, graft survival was not significantly different after 3 years (65 ± 10% vs. 76 ± 9%), though the combined KLAL-DALK group showed greater visual acuity (VA) improvement, with no greater complication or rejection rates.…”

A Review of Contact Lens-Induced Limbal Stem Cell Deficiency

“…Studies have demonstrated successful treatment of CL-induced LSCD through PK with other adjunct treatments like corticosteroids [36] and limbal transplantation [42,96,97]. In cases of significant corneal scarring caused by CL-induced LSCD, deep anterior laellar keratoplasty is the preferred option for corneal scar remodeling and effective visual outcomes [98]. It should be performed after LSCD has resolved and after or simultaneously with limbal transplantation [98].…”

“…In cases of significant corneal scarring caused by CL-induced LSCD, deep anterior laellar keratoplasty is the preferred option for corneal scar remodeling and effective visual outcomes [98]. It should be performed after LSCD has resolved and after or simultaneously with limbal transplantation [98].…”