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Long-term outcome and prognostic factor analysis for keratolimbal allografts

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Abstract

Purpose

To evaluate the long-term results of keratolimbal allograft (KLAL) and elucidate the prognostic factors of KLAL survival.

Methods

Twenty-four eyes of 22 patients underwent KLAL one or more times, and were followed up more than 1 year postoperatively. Their medical records were reviewed. The success of KLAL and penetrating keratoplasty (PKP) was evaluated. KLAL success was defined as absence of persistent corneal epithelial defect, corneal conjunctivalization, or neovascularization on the corneal edge of the graft. Prognostic factors for survival of KLAL were analyzed, including preoperative diagnosis, history of graft rejection, symblepharon, concurrent surgery, immunosuppressant dose, and interval for full epithelialization time. The prognostic factors were evaluated by univariate survival analysis or multivariate Cox proportional hazards survival regression.

Results

KLAL had been successful in 33.3% of the eyes over an average of 47.9 months. Fifteen episodes of KLAL rejection developed in ten eyes (41.7%), but 13 cases (86.7%) were reversible. Of 45 KLAL procedures, eyelid deformity, symblepharon, and the interval of full epithelialization were significantly associated with KLAL success by univariate analysis, and the presence of symblepharon was identified by multivariate Cox regression analysis as the most important prognostic factor to affect KLAL outcome (p = 0.010).

Conclusions

KLAL has been partly successful for reconstruction of limbal stem cell deficiency, and symblepharon has been identified as a significant prognostic factor for KLAL survival. Surgical correction of symblepharon is important before KLAL and PKP.

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Acknowledgement

There was no government and non-government support. The authors have no financial or other proprietary interest in any material or method mentioned in this article.

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Authors and Affiliations

  1. Department of Ophthalmology, Seoul National University College of Medicine, #101 Daehakro, Chongno-Gu, Seoul, 110-744, Korea

    Eui Seok Han, Won Ryang Wee & Mee Kum Kim

  2. Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

    Eui Seok Han, Won Ryang Wee, Jin Hak Lee & Mee Kum Kim

  3. Seoul National University Bundang Hospital, Seoul, Korea

    Jin Hak Lee

Authors
  1. Eui Seok Han
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  2. Won Ryang Wee
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  3. Jin Hak Lee
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Correspondence to Mee Kum Kim.

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Commercial interest or financial relationship: none

We have full control of all primary data, and we agree to allow Graefe's Archive for Clinical and Experimental Ophthalmology to review our data upon request.

Institutional review board (H-1006-143-322).

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Han, E.S., Wee, W.R., Lee, J.H. et al. Long-term outcome and prognostic factor analysis for keratolimbal allografts. Graefes Arch Clin Exp Ophthalmol 249, 1697–1704 (2011). https://doi.org/10.1007/s00417-011-1760-3

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  • DOI: https://doi.org/10.1007/s00417-011-1760-3

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