Journal article
Outcomes and Complications of Limbal Stem Cell Allograft Transplantation: A Report by the American Academy of Ophthalmology
Ophthalmology (Rochester, Minn.), Vol.131(9), pp.1121-1131
09/2024
DOI: 10.1016/j.ophtha.2024.02.018
PMID: 38678469
Abstract
To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency (LSCD).
Literature searches were last conducted in the PubMed database in February 2023 and were limited to the English language. They yielded 523 citations; 76 were reviewed in full text, and 21 met the inclusion criteria. Two studies were rated level II, and the remaining 19 studies were rated level III. There were no level I studies.
After KLAL surgery, best-corrected visual acuity (BCVA) improved in 42% to 92% of eyes at final follow-up (range, 12-95 months). The BCVA was unchanged in 17% to 39% of eyes and decreased in 8% to 29% of eyes. Two of 14 studies that evaluated the results of KLAL reported a notable decline in visual acuity over time postoperatively. Survival of KLAL was variable, ranging from 21% to 90% at last follow-up (range, 12-95 months) and decreased over time. For patients undergoing lr-CLAL surgery, BCVA improved in 31% to 100% of eyes at final follow-up (range, 16-49 months). Of the 9 studies evaluating lr-CLAL, 4 reported BCVA unchanged in 30% to 39% of patients, and 3 reported a decline in BCVA in 8% to 10% of patients. The survival rate of lr-CLAL ranged from 50% to 100% at final follow-up (range, 16-49 months). The most common complications were postoperative elevation of intraocular pressure, persistent epithelial defects, and acute allograft immune rejections.
Given limited options for patients with bilateral LSCD, both KLAL and lr-CLAL are viable choices that may provide improvement of vision and ocular surface findings. The studies trend toward a lower rejection rate and graft failure with lr-CLAL. However, the level and duration of immunosuppression vary widely between the studies and may impact allograft rejections and long-term graft survival. Complications related to immunosuppression are minimal. Repeat surgery may be needed to maintain a viable ocular surface. Reasonable long-term success can be achieved with both KLAL and lr-CLAL with appropriate systemic immunosuppression.
Proprietary or commercial disclosure may be found after the references.
Details
- Title: Subtitle
- Outcomes and Complications of Limbal Stem Cell Allograft Transplantation: A Report by the American Academy of Ophthalmology
- Creators
- Jennifer Y Li - University of California, DavisMaria S Cortina - University of Illinois at ChicagoMark A Greiner - University of IowaAnthony N Kuo - Duke UniversityDarby D Miller - Mayo Clinic in FloridaRoni M Shtein - University of Michigan–Ann ArborPeter B Veldman - University of ChicagoJia Yin - Massachusetts Eye and Ear InfirmaryStephen J Kim - Vanderbilt UniversityJoanne F Shen - Mayo Clinic in Arizona
- Resource Type
- Journal article
- Publication Details
- Ophthalmology (Rochester, Minn.), Vol.131(9), pp.1121-1131
- Publisher
- ELSEVIER SCIENCE INC
- DOI
- 10.1016/j.ophtha.2024.02.018
- PMID
- 38678469
- ISSN
- 0161-6420
- eISSN
- 1549-4713
- Grant note
Funded without commercial support by the American Academy Ophthalmology.
- Language
- English
- Electronic publication date
- 04/27/2024
- Date published
- 09/2024
- Academic Unit
- Pharmaceutical Sciences and Experimental Therapeutics; Ophthalmology and Visual Sciences
- Record Identifier
- 9984621358202771
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