Complications of keratolimbal allograft surgery.
OBJECTIVE
To report postoperative complications of keratolimbal allograft (KLAL) transplantation in patients with bilateral total limbal stem cell deficiency.


METHODS
In this retrospective observational case series, medical charts of 45 patients with at least 6 months of follow-up were reviewed. The main outcome measure was postoperative complications including graft-related issues (thickness, position, and alignment) and immunologic rejection.


RESULTS
Sixty-six KLALs were performed on 45 eyes. The mean follow-up period was 26.1 ± 11.8 months (range, 6-48 months). Primary failure occurred in 5 eyes primarily as a result of ocular surface exposure and severe dry eyes. Graft-related complications included misalignment (4 eyes), buttonhole (4), inner-edge tear (4), inadvertent limbal trephination (2), and thick KLAL (2). Postoperatively, regional thinning of the graft was observed in 8 KLALs as a result of exposure, regional ischemia, and after epithelial rejection. Acute rejection was diagnosed 16 times in 8 eyes, whereas chronic rejection was observed in 24 eyes. At last follow-up, 12 cases (26.6%) had failed because of recurrent acute rejection (4), chronic rejection (5), refractory herpetic keratitis (1), exposure (1), and refractory papillomavirus keratitis (1).


CONCLUSIONS
KLAL may be complicated by several adverse events. The most important complications are immunologic rejections, chronic ocular surface exposure, and graft-related complications.
Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, USA.
Alireza
A
Baradaran-Rafii
Medi
M
Eslani
Ali R
AR
Djalillian
D000293:Adolescent; D000328:Adult; D017690:Cell Transplantation / Q000379:methods*; D002648:Child; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D004359:Drug Therapy, Combination; D019573:Epithelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016850:Limbus Corneae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011183:Postoperative Complications; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D014184:Transplantation, Homologous; D055815:Young Adult
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus