title: Clinical results and influential factors of modified large-diameter lamellar keratoplasty in the treatment of total limbal stem cell deficiency.
abstract: OBJECTIVE
  To analyze the clinical results and potential influential factors of modified large-diameter lamellar keratoplasty in patients with total limbal stem cell deficiency.
  
  
  METHODS
  Thirty-six eyes of 35 patients were included in this study. Best-corrected visual acuity, ocular surface stability, central corneal graft clarity, and postoperative complications were recorded. Related influential factors were evaluated using Cox regression analysis.
  
  
  RESULTS
  At the final follow-up (mean, 48.1 ± 43.2 months), 21 eyes (58.3%) had an improvement in best-corrected visual acuity of at least 1 line. Twenty-seven eyes (75.0%) had a stable ocular surface. The survival of ocular surface stability was 74.4% ± 7.4%, 58.9% ± 8.5%, 51.1% ± 9.0%, and 39.3% ± 9.2% at 1, 2, 5, and 7 years after surgery, respectively. Twenty-one eyes (58.3%) maintained a clear graft. The survival of central graft clarity was 74.4% ± 7.4%, 59.5% ± 8.4%, 55.2% ± 8.8%, and 46.7% ± 9.3% at 1, 2, 5, and 7 years after surgery, respectively. Thirteen eyes (36.1%) developed persistent epithelial defects, and immune rejection occurred in 9 eyes (25.0%). The Cox regression analysis revealed that previous eyelid reconstruction [relative risk (RR) = 0.035] and combination with subconjunctival implantation of a cyclosporine A drug delivery system (RR = 0.170) were protective factors. Preoperative persistent epithelial defects (RR = 3.443) and decreased Schirmer test (RR = 6.770) were risk factors associated with ocular surface stability.
  
  
  CONCLUSIONS
  The modified large-diameter lamellar keratoplasty seems to be effective in reconstructing an ocular surface with long-term stability. Improvement in tear production, reconstruction of eyelid abnormalities, and combination with subconjunctival implantation of an immunosuppressive drug delivery system can help to maintain a stable ocular surface.
authors.affiliation: Qingdao University Medical College, Qingdao, China. lixin_xie@yahoo.com
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Qi
authors.forename: Lixin
authors.initials: L
authors.lastname: Xie
authors.forename: Jun
authors.initials: J
authors.lastname: Cheng
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
mesh_terms: D002057:Burns, Chemical / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003315:Cornea / Q000502:physiology; D003316:Corneal Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D016572:Cyclosporine / Q000627:therapeutic use; D019573:Epithelium, Corneal / Q000473:pathology; D005126:Eye Burns / Q000139:chemically induced*; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D013234:Stem Cells / Q000473:pathology*; D013666:Tears / Q000502:physiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine