Outcomes and Complications of Limbal Stem Cell Allograft Transplantation: A Report by the American Academy of Ophthalmology.

Autor:	Li JY; UC Davis Eye Center, University of California, Davis, California., Cortina MS; Department of Ophthalmology and Visual Science, University of Illinois College of Medicine, Chicago, Illinois., Greiner MA; Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa., Kuo AN; Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina., Miller DD; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida., Shtein RM; Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan., Veldman PB; Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois., Yin J; Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts., Kim SJ; Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee., Shen JF; Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona.
Jazyk:	angličtina
Zdroj:	Ophthalmology [Ophthalmology] 2024 Sep; Vol. 131 (9), pp. 1121-1131. Date of Electronic Publication: 2024 Apr 27.
DOI:	10.1016/j.ophtha.2024.02.018
Abstrakt:	Purpose: To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency (LSCD). Methods: Literature searches were last conducted in the PubMed database in February 2023 and were limited to the English language. They yielded 523 citations; 76 were reviewed in full text, and 21 met the inclusion criteria. Two studies were rated level II, and the remaining 19 studies were rated level III. There were no level I studies. Results: After KLAL surgery, best-corrected visual acuity (BCVA) improved in 42% to 92% of eyes at final follow-up (range, 12-95 months). The BCVA was unchanged in 17% to 39% of eyes and decreased in 8% to 29% of eyes. Two of 14 studies that evaluated the results of KLAL reported a notable decline in visual acuity over time postoperatively. Survival of KLAL was variable, ranging from 21% to 90% at last follow-up (range, 12-95 months) and decreased over time. For patients undergoing lr-CLAL surgery, BCVA improved in 31% to 100% of eyes at final follow-up (range, 16-49 months). Of the 9 studies evaluating lr-CLAL, 4 reported BCVA unchanged in 30% to 39% of patients, and 3 reported a decline in BCVA in 8% to 10% of patients. The survival rate of lr-CLAL ranged from 50% to 100% at final follow-up (range, 16-49 months). The most common complications were postoperative elevation of intraocular pressure, persistent epithelial defects, and acute allograft immune rejections. Conclusions: Given limited options for patients with bilateral LSCD, both KLAL and lr-CLAL are viable choices that may provide improvement of vision and ocular surface findings. The studies trend toward a lower rejection rate and graft failure with lr-CLAL. However, the level and duration of immunosuppression vary widely between the studies and may impact allograft rejections and long-term graft survival. Complications related to immunosuppression are minimal. Repeat surgery may be needed to maintain a viable ocular surface. Reasonable long-term success can be achieved with both KLAL and lr-CLAL with appropriate systemic immunosuppression. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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