Long-term Outcome of Keratolimbal Allograft for Total Limbal Stem Cell Deficiency Using Combined Immunosuppressive Agents
梁凌毅 刘祖国 Hosam Sheha Scheffer Tseng
中山眼科中心 Ocular Surface Center Ocular Surface Research and Education Foundation Miami Florida USA
厦门大学医学院 510060
Objective：To determine the long-term outcome of keratolimbal allograft(KLAL).
Method:Scores of risks were accounted and managed before，during，and after KLAL.Prolonged oral mycophenolate mofetil(MMF)and tacrolimus(TAC)were administered consecutively in 12 eyes(10 patients)with total limbal stem cell deficiency(LSCD)for a minimal 36 months follow up postoperatively.
Results:More corrective measures were required for eyes with higher risk scores.Postoperative epithelial breakdown due to exposure occurred late after PKP and remained a primary threat.Average 1.4 g/d MMF and 1.6 mg/d TAC was administered for 51.8±23.9 months with few side effects.KLAL and PKP rejection was noted in 2 and 3 eyes，respectively，but reversed in 1 eye each，yielding final survival of KLAL and PKP in 10 and 8 eyes，respectively，and ambulatory vision up to 20/20 in 10 eyes for 67.2%of the entire follow up period.
Conclusions:Correction of ocular surface deficits plus combined immunosuppressive regimen further improves the long-term outcome of KLAL in eyes with total LSCD.
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