Long-term outcomes of keratolimbal allografts and conjunctival limbal autografts for total limbal stem cell deficiency

Session Details

Session Title: Presented Poster Session: Cornea - Surgical

Session Date/Time: Saturday 05/09/2015 | 15:00-16:30

Paper Time: 16:10

Venue: Poster Village: Pod 4

First Author: : M.Ziaei UK

Co Author(s): :    L. Ficker   A. Shortt           

Abstract Details

Purpose:

To evaluate the long-term (10 year) outcomes of ocular surface reconstruction using keratolimbal allografting (KLAL) and conjunctival-limbal autografts (CLAU) in patients with total limbal stem cell deficiency (LSCD).

Setting:

Cornea and External Diseases Service, Moorfields Eye Hospital, London, UK.

Methods:

A retrospective non-comparative review of thirteen eyes of 11 patients with total LSCD, who had a preoperative best-corrected Snellen visual acuity of less than 6/36 and a minimum follow-up of 5 years was conducted. Aetiologies included chemical injury (39%), aniridia (23%), epithelial dysplasia (15%), pseudopterygia (15%) and trachoma (8%). All patients underwent a single KLAL or CLAU procedure. If needed, penetrating keratoplasty (PKP) was performed at the same surgical setting.

Results:

Ten eyes (77%) received allografts and three eyes autografts (23%). Mean follow-up was 120.0 +/- 40.3 months (range, 60.5-180.6). All patients received topical steroids postoperatively with 46% also receiving oral steroids and15% receiving oral steroids and cyclosporine. All eyes successfully re-epithelialised. Outcomes were similar for allografts and autografts. Eight eyes (62%) gained a mean of 2.8 lines of Snellen visual acuity (VA), two eyes (15%) retained their preoperative VA whilst three eyes (23%) lost visual acuity. At final follow-up graft clarity was maintained in 76% of eyes. Impression cytology revealed a normal corneal phenotype in only 23% of eyes.

Conclusions:

Keratolimbal allografts and conjunctival limbal autografts can improve visual acuity in up to 62% of treated patients with LSCD for up to 10years. However, impression cytology outcomes show long-term restoration of a normal corneal phenotype in only 23% of cases. Allograft and autografts outcomes were similar in this case series.

Financial Interest:

NONE