Section for Cornea and Ocular surface disease, Department of Ophthalmology, Labbafinejad medical center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and.
Ophthalmic Research Center, Research Institute for Ophthalmology and Visual Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Cornea. 2023 May 1;42(5):656-661. doi: 10.1097/ICO.0000000000003199. Epub 2022 Dec 12.
The purpose of this study was to present a novel surgical technique combining 360-degree keratolimbal allograft (KLAL) and simultaneous central keratoplasty termed en bloc KLAL with the central penetrating keratoplasty (PKP) performed in those cases with total limbal stem cell deficiency (LSCD) and corneal scars.
Nine eyes of 9 patients underwent en bloc KLAL and central PKP between 2014 and 2016. All patients had bilateral total LSCD with total corneal opacity due to different etiologies. The exclusion criteria were previous limbal stem cell transplantation and the presence of active and uncontrolled ocular surface inflammation. The same donor globe was used for harvesting 360-degree KLAL and central PKP. The 1-piece integrity of the KLAL and PKP graft was preserved during the described technique. All patients received modified immunosuppressive regimens compatible with the Cincinnati solid organ transplantation protocol.
The average age of patients was 58.6 ± 18.6 years. The diagnosis was mustard gas keratopathy in 6, herpes simplex keratitis in 1, and severe acid chemical burn in 2 patients. Seven patients were male. An integrated ocular surface without epitheliopathy and a clear cornea was achieved in 8 patients (88.8%) with an average of 6.5 years in follow-up. The average best-corrected visual acuity was 1.89 ± 0.18 (20/1600) preoperatively which improved to 1.02 ± 0.64 (20/200) logMAR in the postoperative period. Endothelial immune rejection episodes were observed in 3 patients. KLAL rejection was not observed in any patient. One patient required repeat PKP due to corneal graft failure.
En bloc 360-degree KLAL and central PKP could simultaneously be performed in patients with total LSCD and corneal opacification.
本研究旨在介绍一种新的手术技术，即将 360 度角巩膜缘异体（KLAL）与同时进行的中央穿透性角膜移植（PKP）相结合，用于治疗完全角结膜干细胞缺乏症（LSCD）和角膜瘢痕的患者。
2014 年至 2016 年期间，9 例 9 只眼接受了整块 KLAL 和中央 PKP。所有患者均因不同病因双侧完全 LSCD 伴全角膜混浊。排除标准为先前的角膜缘干细胞移植和活动性及不可控的眼表炎症。KLAL 和中央 PKP 的供体球均来自同一供体。在描述的技术中，KLAL 和 PKP 移植物的 1 件完整性得以保留。所有患者均接受了与辛辛那提实体器官移植方案兼容的改良免疫抑制方案。
患者平均年龄为 58.6 ± 18.6 岁。诊断为 6 例芥子气角膜炎、1 例单纯疱疹性角膜炎和 2 例严重酸化学烧伤。7 例为男性。7 例（88.8%）患者获得了完整的眼表，无上皮病，角膜清晰，平均随访 6.5 年。平均最佳矫正视力从术前的 1.89 ± 0.18（20/1600）提高到术后的 1.02 ± 0.64（20/200）logMAR。3 例患者发生内皮免疫排斥反应。无患者出现 KLAL 排斥反应。1 例患者因角膜移植失败需要再次进行 PKP。
整块 360 度 KLAL 和中央 PKP 可同时用于治疗完全 LSCD 和角膜混浊的患者。
