title: Long-term outcomes of keratolimbal allograft for total limbal stem cell deficiency using combined immunosuppressive agents and correction of ocular surface deficits.
abstract: OBJECTIVE
  To determine the long-term outcomes of keratolimbal allograft (KLAL).
  
  
  METHODS
  Scores of such risks as infrequent blinking, blink-related microtrauma, conjunctival inflammation, elevated intraocular pressure, dry eye, symblepharon, lagophthalmos, and previous KLAL or penetrating keratoplasty (PKP) failure were calculated and recorded before, during, and after KLAL. Prolonged oral mycophenolate mofetil and tacrolimus and short-term prednisone and acyclovir were administered in 12 eyes (10 consecutive patients) with total limbal stem cell deficiency after KLAL. Ten eyes underwent subsequent PKP.
  
  
  RESULTS
  More corrective measures were required in eyes with higher risk scores. During a follow-up of 61.2 months (standard deviation [SD], 18.2; range, 36-91 months) after KLAL, postoperative epithelial breakdown due to exposure occurred late in the period after PKP and remained a primary risk. Mean daily doses of 1.4 g of mycophenolate mofetil and 1.6 mg of tacrolimus were administered for 52.7 months (SD, 22.5; range, 23-91 months) with few adverse effects and reached trough levels of 1.6 microg/mL (SD, 0.6 microg/mL) and 4.5 ng/mL (SD, 2 ng/mL), respectively. Keratolimbal allograft and PKP rejection was noted in 2 and 3 eyes, respectively, though there was a reversal in 1 eye in each group, yielding final KLAL and PKP survivals in 10 and 8 eyes, respectively, and ambulatory visual acuity of up to 20/20 in 10 eyes for 67.2% of the entire follow-up period.
  
  
  CONCLUSIONS
  Correction of ocular surface deficits combined with an immunosuppressive regimen further improves the long-term outcome of KLAL in eyes with total limbal stem cell deficiency.
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Ocular Surface Disease Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Lingyi
authors.initials: L
authors.lastname: Liang
authors.forename: Hosam
authors.initials: H
authors.lastname: Sheha
authors.forename: Scheffer C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation; D003131:Combined Modality Therapy; D003316:Corneal Diseases / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D004359:Drug Therapy, Combination; D004847:Epithelial Cells / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016850:Limbus Corneae / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D012307:Risk Factors; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000473:pathology; D013536:Suture Techniques; D016559:Tacrolimus / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus