Long-term clinical outcome of Keratolimbal Allograft in Chronic and Delayed-Onset Mustard Gas Keratopathy from a Tertiary Referral Eye Center
Kiana Hassanpour1 *, Farid Karimian 1 , Mohammad-Reza Jafarinasab1 , Alireza Baradaran-Rafii1 , Sepehr Feizi1 , Mohammadali Javadi 1 , Mohammad-Hassan Alemzadeh-Ansari1
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: To investigate the long-term clinical outcome of Keratolimbal allograft (KLAL) in patients with Delayed-onset Mustard Gas Keratopathy (MGK).
Methods: Patients with delayed-onset MGK undergoing KLAL with or without corneal transplantation were enrolled between 2002 and 2016 in this retrospective interventional case series. The primary outcome was the success rate of the KLAL demonstrated by Kaplan-Meier cumulative survival analysis. The secondary outcomes were postoperative best-corrected visual acuity and the need for further surgery.
Results: A total of 108 eyes of 68 patients with MGK underwent KLAL. All patients were men with an average age of 54 ± 6 years at the time of surgery. The average follow-up duration was 81.9 ± 38.4 months. The type of surgery included sectoral KLAL in 62 eyes (57.4%), Sectoral KLAL combined with lamellar keratoplasty (LK) in 40 eyes (37%) and combined with Penetrating Keratoplasty (PK) in 6 (5.6%) eyes. The cumulative probability of success was 75 % within the follow-up duration.
Of these eyes, 88.1% needed one operation for stabilizing the ocular surface. Average best-corrected visual acuity (BCVA) did not change after KLAL except improving in those cases accompanied by LK. Patients with combined LK achieved superior clinical outcomes compared to stand-alone KLAL. Infectious keratitis occurred in 6 (5.5%) eyes. No adverse events due to systemic immunosuppression were observed.
Conclusion: KLAL alone or combined with LK is effective, durable, and visually acceptable in the reconstruction of the ocular surface in patients with Limbal stem cell deficiency secondary to MGK.
