Long-term outcome of keratolimbal allograft with or without penetrating keratoplasty for total limbal stem cell deficiency

Solomon, Abraham; Ellies, Pierre; Anderson, David F.; Touhami, Amel; Grueterich, Martin; Espana, Edgar M.; Ti, Seng Ei; Goto, Eiki; Feuer, William J.; Tseng, Scheffer C.G.

doi:10.1016/s0161-6420(02)00960-0

Cited by 297 publications

(202 citation statements)

References 30 publications

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“…The improvements achieved one year after surgery could be kept in the majority of patients at the long-term follow-up (mean, 48.7 ± 30.6 months) (Figure 4). Of the group of eyes that gained VA one year after surgery, 66.6% still maintained an improved VA, and 94.7% of eyes that have achieved ambulatory vision at one year after surgery maintained 20/200 or better at the final follow-up, similar to previous reports (20) . In addition, of the group of eyes that had a stable corneal surface one year after surgery, 93.9% still had a stable corneal surface at the last follow-up, data confirmed on the survival curve.…”

Section: Discussionsupporting

confidence: 89%

“…Snellen visual acuity (VA), ambulatory vision -defined when the best-corrected visual acuity was 20/200 or better (20) -and surface stability -measured as presence or absence of corneal epithelial defect where fluorescein drop examinations were evaluated pre-and postoperatively as main out- comes. Corneal transparency -measured as totally transparent cornea, mild opacity not obscuring iris details, mild opacity obscuring iris details or totally opaque cornea -and neovascularization -measured in millimeters through the visual axis -were evaluated as secondary outcomes.…”

Section: Methodsmentioning

confidence: 99%

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HLA-matched living-related conjunctival limbal allograft for bilateral ocular surface disorders: long-term results

Scocco¹,

Kwitko

Rymer³

et al. 2008

Arq. Bras. Oftalmol.

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20/200) and ocular surface stability were evaluated as main outcomes. Donor limbus was obtained from a sibling or a parent of the patient, after an appropriate Class I and II HLA match. RESULTS: One year after surgery, VA improved in 46.2%, ambulatory vision was achieved in 48.7% and a stable corneal surface was achieved in 84.6% of the eyes. At the final follow-up (mean, 48.7 ± 30.6 months), 66.6% of the eyes that had gained VA one year after surgery maintained an improved VA (p=0.28), 94.7% of eyes that had achieved ambulatory vision one year after surgery maintained 20/200 or better (p<0.001) and 93.9% still had a stable corneal surface (p=0.043) at the final follow-up. CONCLUSIONS: HLA-matched lr-CLAL can be an adequate method of treatment for bilateral ocular surface disorders, with a reasonable percentage of success of long-term results.]]>

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

HLA-matched living-related conjunctival limbal allograft for bilateral ocular surface disorders: long-term results

Scocco¹,

Kwitko

Rymer³

et al. 2008

Arq. Bras. Oftalmol.

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“…The results were similar to those reported in keratolimbal allograft transplantation (KLAL). 15,27,28 The rate of success seemed to be worse than the previous reports 1, 3,5,12 , and the difference was probably attributed to the differences in patient selection and preoperative condition.…”

Section: Discussionmentioning

confidence: 70%

Factors Influencing Outcomes in Cultivated Limbal Epithelial Transplantation for Chronic Cicatricial Ocular Surface Disorders

Shimazaki

Higa

Morito

et al. 2007

American Journal of Ophthalmology

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Cultivated limbal epithelial transplantation (CLET) is a recently developedsurgical method to reconstruct the ocular surface in eyes with limbal dysfunction. The concept of the CLET is to produce a limbal epithelial sheet containing progenitor cells of the corneal epithelium, and then to transplant to the ocular surface following excision of cicatricial tissues. The method was first reported by Pellegrini et al in 1997, followed by several other investigators including our group. [1][2][3][4][5][6][7][8][9][10][11][12] In our previous report in 2002, the short-term outcomes of CLET were comparable with conventional limbal epithelial transplantation. 7 We found that the method did not produce excellent outcomes in patients with severe cicatricial ocular surface disorders such as Stevens-Johnson syndrome (SJS) and chemical/thermal burns of the cornea. 7 This may be due to the fact that many of the patients had risk factors for poor epithelialization such as decreased tear production, lid abnormalities, persistent inflammation. [13][14][15] It is not clear whether the relatively poor outcomes of our previous report can be improved by the modification of the epithelial sheet preparation. There are a variety of factors that may influence the quality of the epithelial sheet, which include; source of cells, preparation of the cells, types of substrates used, cultivation medium, the use of feeder cells, and culture conditions. Our group has made some modification of the cultivation/preparation methods including the use of feeder cells, cell suspension technique and air-lifting of the cell sheet.In order to investigate whether the modification resulted in improvement in surgical outcomes, we retrospectively studied the mid-term outcomes of CLET. The mid-term outcomes of CLET for chronic cicatricial ocular surface disorders were compared with the different cultivation methods. Also, other factors were analyzed to see if they influenced the results. METHODS PatientsTwenty nine eyes of 27 patients that had CLET between June 1999 and November 2003 were retrospectively analyzed in this study. Patients consisted of 16 males and 11 females, with a mean age of 50.2 + 20.7 years (15-82 years). All eyes had total limbal dysfunction. Conjunctivalization was confirmed preoperatively by impression cytology in 10 of 27 eyes. Mean corrected visual acuity was counting fingers, and two-third of the eyes had less than 20/2000. Schirmer`s test was performed in 21 eyes and decreased tear secretion (Schirmer`s value < 5 mm) was noted in 12 eyes. As for preoperative complications, glaucoma, macular degeneration, and lid deformity were noted in 4, 1, and 3 eyes, respectively.

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“…If the injury is unilateral, then donor tissue may be harvested from the unaffected eye and transplanted to the injured eye, but for bilateral disease cadaveric donor tissue is required. 29 Because an autograft does not face a risk of rejection, it is the benchmark for the potential of this type of surgery. There are two techniques for autograft transplantation.…”

Section: Late Phase Managementmentioning

confidence: 99%

Surgical rehabilitation following severe ocular burns

Tuft

Shortt

2009

Eye

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Long-term outcome of keratolimbal allograft with or without penetrating keratoplasty for total limbal stem cell deficiency

Cited by 297 publications

References 30 publications

HLA-matched living-related conjunctival limbal allograft for bilateral ocular surface disorders: long-term results

HLA-matched living-related conjunctival limbal allograft for bilateral ocular surface disorders: long-term results

Factors Influencing Outcomes in Cultivated Limbal Epithelial Transplantation for Chronic Cicatricial Ocular Surface Disorders

Surgical rehabilitation following severe ocular burns

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