Background: Limbal stem cell deficiency (LSCD) is a rare ocular complication of graft-versus-host disease (GVHD) that causes severe visual impairment. Here, we present the case of successful keratolimbal allograft (KLAL) surgery in a patient with chronic ocular GVHD and concurrent bilateral LSCD.
Case: A 64-year-old man with acute myeloid leukemia underwent bone marrow transplantation. Following acute GVHD and corneal perforation in the left eye as a result of severe dry eye, the patient was referred to the Ophthalmology Department of Tokyo Dental College Ichikawa General Hospital. A 1-mm-wide perforation was observed in the inferior central cornea of the left eye. Amniotic membrane tran s plantation was performed, and the corneal perforation was closed. Two years after bone marrow transplantation, the patient developed bilateral LSCD and was referred to the hospital again. Bilateral KLAL was performed. Conjunctivalization, characterized by the covering of the corneal surface with highly thickened conjunctival tissue, was present in both eyes, but the corneal stroma was clear. Conjunctival epithelization was smoothly achieved after surgery. The patient's visual acuity improved from 0.02 (n. c.) in OD and 10 cm finger count (n. c.) in OS to 0.3 in OD and 0.04 in OS. Episodes of KLAL rejection did not occur after the administration of an adrenocortical steroid and oral cyclosporine, both of which were prescribed by a physician for the treatment of GVHD, and a betamethasone sodium phosphate eye drop, which was prescribed by an ophthalmologist. Histological evaluation of the conjunctiva of the left eye revealed fibrosis and inflammatory cell infiltration, including interstitial lymphocytes and plasmacytes. These findings, i. e., a nonspecific chronic inflammatory condition, were consistent with those of chronic ocular GVHD.
Conclusion: Patients with chronic ocular GVHD may experience severe visual impairment due to LSCD. KLAL can be one of the most effective surgical techniques if such a condition develops.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 606-613,2023.