En-Bloc Penetrating Keratoplasty With Annular Keratolimbal Allograft Transplantation: Surgical Technique to Manage Total Limbal Stem Cell Deficiency
Purpose
To describe a novel method of simultaneous en-bloc central penetrating keratoplasty (PK) and peripheral lamellar keratoplasty (LK) with annular keratolimbal allograft (KLAL) transplantation in patients with severe limbal stem cell deficiency (LSCD).
Methods
Retrospective, noncomparative interventional case series. Seven eyes of 7 consecutive patients with total LSCD secondary to mustard gas keratopathy, chemical burn, Stevens-Johnson syndrome (SJS), ocular cicatricial pemphigoid (OCP) and aniridia as defined by impression cytology, who had a preoperative best-corrected visual acuity of less than 20/200 and a minimum follow-up of 6 months were enrolled in the study. All patients underwent central PK and peripheral LK with annular KLAL transplantation by one surgeon (FK) at the same surgical setting using tissue from a unique donor who received a combined immune suppressive protocol including mycophenolate mofetyl, tacrolimus and prednisolone.
Results
Seven patients (all of them were male) simultaneously received en-bloc central PK and peripheral LK with annular KLAL. The mean follow-up time was 18 months (12 -24 months). All eyes had best-corrected visual acuity of >20/200.The one-year survival rate was 100%.The incidence of postoperative complications (corneal epithelium defect, hyphaema and hypotony) were in 2 eyes (28%). Limbal stem cell rejection did not occurred in patients.one graft (14%) had endothelial rejection.
Conclusion
En-bloc penetrating keratoplasty with Annular Keratolimbal Allograft Transplantation is a novel surgical technique in the management of total limbal stem cell deficiency improving vision of these complicated cases in medium-term duration.