Outcomes Of Combined Penetrating Keratoplasty And Limbal Stem Cell Transplantation: Simultaneous Versus Sequential Surgery
Published 2024 - 42nd Congress of the ESCRS
Reference: PP14.16 | Type: Free paper | DOI: 10.82333/mrx6-6j41
Authors: Ioannis Giachos* 1 , Konstantinos Aggelidis 2 , Spyridon Doumazos 2 , Chara Tzavara 3 , Sotiria Palioura 4
1Ophthalmology,Birmingham and Midland Eye Center,Birmingham,United Kingdom, 2Ophthalmology,National and Kapodistrian University,Athens,Greece, 3Ophthalmology,3. Department of Biostatistics, National and Kapodistrian University of Athens Medical School,Athens,Greece, 4Ophthalmology,4. Department of Ophthalmology, University of Cyprus Medical School,Nicosia,Cyprus
Purpose
To perform a systematic review and meta-analysis of the published studies on limbal stem cell transplantation (LSCT) combined with penetrating keratoplasty (PK) performed either simultaneously or sequentially.
Setting
N/A
Methods
An extensive search was conducted in the MEDLINE and Google Scholar databases. Prospective and retrospective trials and case series reporting on the outcomes of LSCT with PK were included. Primary outcomes were the stability of the ocular surface and the rejection and/or failure of the corneal graft.
Results
A total of 209 eyes from 13 studies were included in the simultaneous group and 489 eyes from 33 studies in the sequential group. Ocular surface stability was 88% (95% confidence interval (CI), 79 - 96%) for sequential cases and 64% (95% CI, 43 - 82%) for simultaneous cases (p=0.001). The graft failure rate was 15% (95% CI, 6 - 26%) for sequential cases and 44% (95% CI= 31 - 58%) for simultaneous cases (p<0.001). For cases performed sequentially, subgroup analysis revealed a stable ocular surface in 97% (95% CI, 91 - 100%) of autograft cases, and 63% (95% CI, 45 - 80%) of allograft cases (p<0.001). The graft failure rate in sequential cases was 7% (95% CI, 0 - 18%) for autografts and 34% (95% CI, 18 - 52%) for allografts (p<0.001).
Conclusions
Sequential LSCT followed by PK demonstrated superior results in terms of ocular surface stability and graft retention compared to simultaneous LSCT and PK. Limbal stem cells of autologous origin fare better than allogeneic ones in sequential cases.
Keywords: Penetrating Keratoplasty, Conjunctival Limbal Autograft, Living-Related Conjunctival Limbal Allograft (LR-CLAL), Keratolimbal Allograft, Cultivated Limbal Epithelial Transplant (CLET), Simple Limbal Epithelial Transplantation (SLET)
doi: 10.1097/ICO.0000000000003261