Outcomes Of Keratolimbal Allograft From Matched Donors For Severe Bilateral Limbal Stem Cell Deficiency

To report outcomes of keratolimbal allograft (KLAL) with or without living-related conjunctival-limbal allograft (lr-CLAL) surgery from human leukocyte (HLA) and blood type matched cadaver donor tissue using the Cincinnati systemic immunosuppression (SI) protocol and intravenous immunoglobulin (IVIG).

Academic Tertiary Care Center.

This was a retrospective interventional case series from a single tertiary referral institution of consecutive patients who underwent KLAL for limbal stem cell deficiency (LSCD) from HLA and blood type matched deceased donor tissue with a minimum follow-up time of 12 months. The main outcome measures were ocular surface stability, visual acuity and SI adverse events.

Eight eyes (n=8) with a mean age of 48.6±10.1 years were included in this study. Mean follow-up time was 37.3±22.7 months (12-71 months) following KLAL, four of which (50%) had combined lr-CLAL. The etiologies of LSCD were Stevens-Johnson Syndrome (n=4/8), aniridic LSCD (n=2/8), chemical injury (n=1/8) and end stage meibomian gland dysfunction secondary to atopic eye disease (n=1/8). At the last follow-up, 7 eyes (87.5%) had a stable ocular surface and 1 eye (12.5%) developed failure and subsequently required a keratoprosthesis. There was a significant improvement in logarithm of the minimum angle of resolution (logMAR) visual acuity from 1.65±0.48 to 0.68±0.34 (p=0.01). SI was tolerated well by all patients with minimal adverse events.

Preliminary outcomes of KLAL with or without lr-CLAL following HLA and blood-type matching using the Cincinnati protocol with IVIG are encouraging. This protocol may allow for utilization of deceased donor tissue with results approximating those of live donor tissue for the treatment of severe bilateral limbal stem cell deficiency.