Simultaneous deep anterior lamellar keratoplasty and limbal allograft in bilateral limbal stem cell deficiency
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To report the efficacy of simultaneous keratolimbal allograft (KLAL) surgery and deep anterior lamellar keratoplasty (DALK) for limbal stem cell deficiency (LSCD).
We conducted a retrospective, interventional case series of six consecutive eyes of five patients with LSCD and stromal opacity due to gelatinous drop-like dystrophy (two eyes), Stevens-Johnson syndrome (SJS, two eyes), or aniridia (two eyes). Only patients with normal lid anatomy and Schirmer test values greater than 3 mm were enrolled. DALK was performed by viscodissection followed by a thin, 360° KLAL designed by using an artificial anterior chamber. KLAL sutures were removed after 2 weeks.
DALK and KLAL were successfully performed in all eyes, which were followed for an average of 17.2 ± 10.8 months. All eyes recovered a smooth corneal epithelium, although one SJS patient developed a persistent epithelial defect (PED) leading to opacification of the central cornea. Visual acuity improved by more than 2 lines in all eyes except that of the SJS patient with PED. No other complications were observed.
Simultaneous DALK and thin-section KLAL is an effective treatment for ocular surface disease in patients with residual tear function and normal lid anatomy.
- Tsubota K, Satake Y, Kaido M, et al. Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation. N Engl J Med 1999;340:1697–1703. CrossRef
- Tsai RJ, Tseng SC. Human allograft limbal transplantation for corneal surface reconstruction. Cornea 1994;13:389–400. CrossRef
- Tseng SC, Prabhasawat P, Barton K, Gray T, Meller D. Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency. Arch Ophthalmol 1998;116:431–441.
- Koizumi N, Inatomi T, Suzuki T, Sotozono C, Kinoshita S. Cultivated corneal epithelial stem cell transplantation in ocular surface disorders. Ophthalmology 2001;108:1569–1574. CrossRef
- Nakamura T, Kinoshita S. Ocular surface reconstruction using cultivated mucosal epithelial stem cells. Cornea 2003;22:S75–S80. CrossRef
- Nishida K, Yamato M, Hayashida Y, et al. Functional bioengineered corneal epithelial sheet grafts from corneal stem cells expanded ex vivo on a temperature-responsive cell culture surface. Transplantation 2004;77:379–385. CrossRef
- Cauchi PA, Ang GS, Azuara-Blanco A, Burr JM. A systematic literature review of surgical interventions for limbal stem cell deficiency in humans. Am J Ophthalmol 2008;146:251–259. CrossRef
- Shimazaki J, Maruyama F, Shimmura S, Fujishima H, Tsubota K. Immunologic rejection of the central graft after limbal allograft transplantation combined with penetrating keratoplasty. Cornea 2001;20:149–152. CrossRef
- Solomon A, Ellies P, Anderson DF, et al. Long-term outcome of keratolimbal allograft with or without penetrating keratoplasty for total limbal stem cell deficiency. Ophthalmology 2002;109:1159–1166. CrossRef
- Foulks GN. Glaucoma associated with penetrating keratoplasty. Ophthalmology 1987;94:871–874.
- Sangwan VS, Fernandes M, Bansal AK, Vemuganti GK, Rao GN. Early results of penetrating keratoplasty following limbal stem cell transplantation. Indian J Ophthalmol 2005;53:31–35. CrossRef
- Yao YF, Zhang B, Zhou P, Jiang JK. Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage. Ophthalmology 2002;109:2011–2017. CrossRef
- Shimazaki J, Shimmura S, Tsubota K. Limbal stem cell transplantation for the treatment of subepithelial amyloidosis of the cornea (gelatinous drop-like dystrophy). Cornea 2002;21:177–180. CrossRef
- Coster DJ, Aggarwal RK, Williams KA. Surgical management of ocular surface disorders using conjunctival and stem cell allografts. Br J Ophthalmol 1995;79:977–982. CrossRef
- Dua HS, Azuara-Blanco A. Allo-limbal transplantation in patients with limbal stem cell deficiency. Br J Ophthalmol 1999;83:414–419. CrossRef
- Shimmura S, Shimazaki J, Omoto M, Teruya A, Ishioka M, Tsubota K. Deep lamellar keratoplasty (DLKP) in keratoconus patients using viscoadaptive viscoelastics. Cornea 2005;24:178–181. CrossRef
- Koizumi N, Inatomi T, Suzuki T, Sotozono C, Kinoshita S. Cultivated corneal epithelial transplantation for ocular surface reconstruction in acute phase of Stevens-Johnson syndrome. Arch Ophthalmol 2001;119:298–300.
- Dua HS, Rahman I, Jayaswal R, Said DG. Combined limbal and corneal grafts: should we or should we not? Clin Experiment Ophthalmol 2008;36:497–498. CrossRef
- Shimmura S, Ando M, Shimazaki J, Tsubota K. Complications with one-piece lamellar kerato-limbal grafts for simultaneous limbal and corneal pathologies. Cornea 2000;19:439–442. CrossRef
- Watson SL, Tuft SJ, Dart JK. Patterns of rejection after deep lamellar keratoplasty. Ophthalmology 2006;113:556–560. CrossRef
- Fontana L, Parente G, Tassinari G. Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus. Am J Ophthalmol 2007;143:117–124. CrossRef
- Simultaneous deep anterior lamellar keratoplasty and limbal allograft in bilateral limbal stem cell deficiency
Japanese Journal of Ophthalmology
Volume 54, Issue 6 , pp 537-543
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- deep anterior keratoplasty
- keratolimbal allograft
- limbal stem cell deficiency
- Industry Sectors
- Author Affiliations
- 1. Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- 2. Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan