Midterm outcomes of penetrating keratoplasty following allogeneic cultivated limbal epithelial transplantation in patients with bilateral limbal stem cell deficiency

AIM: To evaluate the midterm outcomes of penetrating keratoplasty (PK) following allogeneic cultivated limbal epithelial transplantation (CLET) for bilateral total limbal stem cell deficiency (LSCD). METHODS: Ten patients (10 eyes) with bilateral LSCD were enrolled in this prospective noncomparative case series study. Each participant underwent PK approximately 6mo after a CLET. Topical tacrolimus, topical and systemic steroids, and oral ciclosporin were administered postoperatively. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular surface grading scores (OSS), corneal graft epithelial rehabilitation, persistent epithelial defect (PED), immunological rejection, and graft survival rate were assessed. RESULTS: The time interval between PK and allogeneic CLET was 6.90±1.29 (6-10)mo. BCVA improved from 2.46±0.32 logMAR preoperatively to 0.77±0.55 logMAR post-PK (P<0.001). Kaplan-Meier analysis of mean graft survival revealed graft survival rates of 100% at 12 and 24mo and 80.0% at 36mo. PEDs appeared in 5 eyes at different periods post-PK, and graft rejection occurred in 4 eyes. The total OSS decreased from 12.4±4.4 before allogeneic CLET to 1.4±1.51 after PK. CONCLUSION: A sequential therapy design of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite the relatively high graft rejection rate.

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Midterm Outcomes of Penetrating Keratoplasty Following Allogeneic Cultivated Limbal Epithelial Transplantation in Patients with Bilateral Limbal Stem Cell Deficiency

10.21203/rs.3.rs-138752/v1 ◽

2021 ◽

Author(s):

Junfa Xue ◽

Dongfang Li ◽

Yani Wang ◽

Chen Chen ◽

Rufei Yang ◽

...

Keyword(s):

Stem Cell ◽

Graft Survival ◽

Graft Rejection ◽

Ocular Surface ◽

Penetrating Keratoplasty ◽

Limbal Stem Cell Deficiency ◽

Topical Tacrolimus ◽

Case Series Study ◽

Limbal Stem Cell ◽

Cultivated Limbal Epithelial Transplantation

Abstract To evaluate the midterm outcomes of penetrating keratoplasty (PK) following allogeneic cultivated limbal epithelial transplantation (CLET) for bilateral total limbal stem cell deficiency (LSCD)，ten patients (10 eyes) with bilateral LSCD were enrolled in this prospective noncomparative case series study. Each participant received a PK approximately 6 months after a CLET. Topical tacrolimus, topical and systemic steroids, and oral ciclosporin were given postoperatively. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular surface grading scores (OSS), corneal graft epithelial rehabilitation, persistent epithelial defect (PED), immunological rejection, and graft survival rate were assessed. The time interval between PK and allogeneic CLET was 6.90 ± 1.29 (6-10) months. BCVA developed from 2.46±0.32 LogMAR preoperatively to 0.77±0.55 LogMAR post-PK (P<0.001). Kaplan-Meier mean graft survival was 100% at 12, 24 months, 80.0% at 36 months. PEDs appeared in 5 eyes at different periods post-PK, while graft rejection post-PK occurred in 4 eyes. Total OSS dropped from 12.4±4.4 before allogeneic CLET to 1.4±1.5 after PK. The sequential therapy of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite a relatively high graft rejection rate. Topical tacrolimus is effective in promoting PK survival post-CLET compared with previous reports.

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