Li Zongyuan, Yang Kunkun, Zhou Yannan, Wu Tengyun, Zhang Hongtao, Yang Qinghua, Wang Qun, Huang Yifei, Wang Liqiang
Medical School of Chinese PLA, Beijing, China.
Department of Ophthalmology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Front Med (Lausanne). 2022 Nov 15;9:986194. doi: 10.3389/fmed.2022.986194. eCollection 2022.
To evaluate and compare the outcome of keratolimbal allograft (KLAL) transplantation with or without deep anterior lamellar keratoplasty (DALK) for bilateral severe limbal stem cell deficiency (LSCD).
This retrospective review included 49 eyes of 46 patients who underwent KLAL transplantation at the Department of Ophthalmology of Chinese PLA general hospital, 2009-2020, for bilateral severe LSCD were examined for corneal clarity and corneal scarring to determine whether to combine DALK with KLAL transplantation. Preoperative information, surgical decision tree, surgical procedures, and postoperative data were collected for each eye.
All patients had preoperative severe or total LSCD. Twenty-four eyes underwent KLAL transplantation only, 25 KLAL transplantation plus DALK. The mean follow-up was 46.80 ± 31.22 months (18-158 months). Overall KLAL survival (with or without DALK) was 71.43% at the final follow-up (KLAL-only 66.67%, KLAL-DALK 76%). Kaplan-Meier survival analysis showed that the 3-year survival probability of all grafts was 70.53 ± 10.89% (KLAL-only 64.86 ± 10.11%, KLAL-DALK 75.79 ± 8.62%). The proportion of BCVA ≥ 20/200 eyes among all KLAL transplantations increased from 11 eyes (22.45%) preoperatively to 25 eyes (51.02%) after 1 year and 24 eyes (48.98%) at the last follow-up ( = 0.01). The proportion of BCVA ≥ 20/200 eyes in the KLAL-DALK group increased significantly ( = 0.04), from 16.0% at baseline to 48.0% after 1 year to 44.0% at the last follow-up. Seventeen eyes (34.69%) had postoperative complications.
KLAL-DALK is an effective option to restore a stable ocular surface and visual acuity rapidly in patients with bilateral, late-stage, severe LSCD.
评估和比较角膜缘移植术（KLAL）联合或不联合深板层角膜移植术（DALK）治疗双侧严重角膜缘干细胞缺乏症（LSCD）的效果。
本回顾性研究纳入了2009年至2020年在中国人民解放军总医院眼科接受KLAL移植术的46例患者的49只眼，这些患者均为双侧严重LSCD，检查角膜透明度和角膜瘢痕情况以确定是否将DALK与KLAL移植术联合应用。收集每只眼的术前信息、手术决策树、手术过程及术后数据。
所有患者术前均有严重或完全性LSCD。24只眼仅接受了KLAL移植术，25只眼接受了KLAL移植术联合DALK。平均随访时间为46.80±31.22个月（18至158个月）。末次随访时，总体KLAL存活率（联合或不联合DALK）为71.43%（仅KLAL组为66.67%，KLAL-DALK组为76%）。Kaplan-Meier生存分析显示，所有移植物的3年存活概率为70.53±10.89%（仅KLAL组为64.86±10.11%，KLAL-DALK组为75.79±8.62%）。所有KLAL移植术中最佳矫正视力（BCVA）≥20/200的眼的比例从术前的11只眼（22.45%）增加到术后1年的25只眼（51.02%），末次随访时为24只眼（48.98%）（P=0.01）。KLAL-DALK组中BCVA≥20/200的眼的比例显著增加（P=0.04），从基线时的16.0%增加到术后1年的48.0%，末次随访时为44.0%。17只眼（34.69%）出现术后并发症。
对于双侧晚期严重LSCD患者，KLAL-DALK是一种能快速恢复稳定眼表和视力的有效选择。
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