title: Simultaneous deep anterior lamellar keratoplasty and limbal allograft in bilateral limbal stem cell deficiency.
abstract: OBJECTIVE
  To report the efficacy of simultaneous keratolimbal allograft (KLAL) surgery and deep anterior lamellar keratoplasty (DALK) for limbal stem cell deficiency (LSCD).
  
  
  METHODS
  We conducted a retrospective, interventional case series of six consecutive eyes of five patients with LSCD and stromal opacity due to gelatinous drop-like dystrophy (two eyes), Stevens-Johnson syndrome (SJS, two eyes), or aniridia (two eyes). Only patients with normal lid anatomy and Schirmer test values greater than 3 mm were enrolled. DALK was performed by viscodissection followed by a thin, 360° KLAL designed by using an artificial anterior chamber. KLAL sutures were removed after 2 weeks.
  
  
  RESULTS
  DALK and KLAL were successfully performed in all eyes, which were followed for an average of 17.2 ± 10.8 months. All eyes recovered a smooth corneal epithelium, although one SJS patient developed a persistent epithelial defect (PED) leading to opacification of the central cornea. Visual acuity improved by more than 2 lines in all eyes except that of the SJS patient with PED. No other complications were observed.
  
  
  CONCLUSIONS
  Simultaneous DALK and thin-section KLAL is an effective treatment for ocular surface disease in patients with residual tear function and normal lid anatomy.
authors.affiliation: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Omoto
authors.forename: Shigeto
authors.initials: S
authors.lastname: Shimmura
authors.forename: Shin
authors.initials: S
authors.lastname: Hatou
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ichihashi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kawakita
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000328:Adult; D000368:Aged; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D016039:Corneal Transplantation; D004847:Epithelial Cells / Q000637:transplantation; D019573:Epithelium, Corneal / Q000637:transplantation*; D005260:Female; D006801:Humans; D016850:Limbus Corneae / Q000166:cytology*; D008875:Middle Aged; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014184:Transplantation, Homologous; D014792:Visual Acuity / Q000502:physiology