Midterm outcomes of penetrating keratoplasty following allogeneic cultivated limbal epithelial transplantation in patients with bilateral limbal stem cell deficiency
Authors:   School of Medicine and Life Sciences, Shandong First Medical University, Jinan 271016, Shandong Province, China; State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University &amp; Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China, Xue Jun-Fa , Wang Ya-Ni ,   State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University &amp; Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China; Medical College, Qingdao University, Qingdao 266071, Shandong Province, China, Chen Chen ,   State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University &amp; Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China; Department of Ophthalmology, Shandong University, Jinan 250100, Shandong Province, China, Yang Ru-Fei ,   State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University &amp; Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China; Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China, Zhou Qing-Jun ,   State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University &amp; Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China, Liu Ting ,   State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University &amp; Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China; Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China, Xie Li-Xin ,   State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University &amp; Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China; Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China, Dong Yan-Ling ,   State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University &amp; Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China; Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
Published: October 2021

AIM: To evaluate the midterm outcomes of penetrating keratoplasty (PK) following allogeneic cultivated limbal epithelial transplantation (CLET) for bilateral total limbal stem cell deficiency (LSCD).
METHODS: Ten patients (10 eyes) with bilateral LSCD were enrolled in this prospective noncomparative case series study. Each participant underwent PK approximately 6mo after a CLET. Topical tacrolimus, topical and systemic steroids, and oral ciclosporin were administered postoperatively. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular surface grading scores (OSS), corneal graft epithelial rehabilitation, persistent epithelial defect (PED), immunological rejection, and graft survival rate were assessed.
RESULTS: The time interval between PK and allogeneic CLET was 6.90±1.29 (6-10)mo. BCVA improved from 2.46±0.32 logMAR preoperatively to 0.77±0.55 logMAR post-PK (P<0.001). Kaplan-Meier analysis of mean graft survival revealed graft survival rates of 100% at 12 and 24mo and 80.0% at 36mo. PEDs appeared in 5 eyes at different periods post-PK, and graft rejection occurred in 4 eyes. The total OSS decreased from 12.4±4.4 before allogeneic CLET to 1.4±1.51 after PK.
CONCLUSION: A sequential therapy design of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite the relatively high graft rejection rate.