Purpose: Allogeneic limbal stem cell transplantation (allo-LT) is an effective treatment for patients with bilateral corneal limbal stem cell deficiency (LSCD). Allo-LT is used to stabilize the ocular surface and improve the visual acuity of patients with LSCD; however, long-term stability is difficult in many cases. Recently, consensus on the treatment strategy of LSCD has been reached worldwide. However, several difficult-to-treat cases persist and factors contributing to clinical prognosis require elucidation. In this study, we investigated factors related to the long-term prognosis after allo-LT.
Participants and methods: A total of 42 eyes of 32 patients with LSCD (mean age 54.3±15.7 years) underwent allo-LT at the Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital from 2011 to 2021. The underlying disease, age, visual acuity, preoperative clinical findings, and postoperative management were compared between the group with a stable ocular surface (stable ocular surface group) and the group with limbal dysfunction (graft dysfunction group) during follow-up.
Results: The most common underlying diseases were Stevens-Johnson syndrome and toxic epidermal necrolysis, accounting for 15 eyes (35.7%), followed by thermal and chemical burns in 11 eyes (26.2%). The stable ocular surface and graft dysfunction groups consisted of 28 eyes (mean follow-up period: 26.5±15.2 months) and 14 eyes (mean follow-up period: 17.6±18.7 months), respectively. Cox hazard analysis revealed that conjunctival congestion (p=0.008), adhesions of the eyelids (p=0.013), changes in the skin and mucosal transition zone (p=0.011), and overall score of ocular surface (p=0.002) were poor prognostic factors for Allo-LT.
Conclusions: Allo-LT for limbal dysfunction resulted in a large proportion of cases with poor prognosis; 66.7% cases showed ocular surface stability. In particular, preoperative conjunctival congestion, symblepharon, and changes in the skin and mucosal transition zone were identified as poor prognostic factors.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 128: 30-37, 2024.