Purchase this article with an account.
Kunal Suri, Stephen Kaufman; Long-Term Outcomes of Patients with Ocular Surface Stem Cell Transplant: 20 years follow-up. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5425.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the long-term outcomes and complications of ocular surface stem cell transplant (OSST).
A retrospective observational case series of patients who had OSST at the University of Minnesota Medical Center between 1990 to 2000, performed by a single surgeon. Patients with minimum one-year follow-up after surgery were included. Demographic data, indication for surgery, further procedures, success rates, complications, duration of immunosuppression, and follow-up time were recorded.
There were a total of 20 eyes of 15 patients with mean age 48.8 ± 15.9 years (25-86 years) at the time of surgery. There were 60% males and 33% had bilateral surgery. The indication for surgery was chemical injury in 8 eyes (40%), aniridia in 7 eyes (35%), iatrogenic limbal stem cell deficiency (LSCD) in 2 eyes (10%), Sjögren’s syndrome in 2 eyes (10%) and Stevens-Johnson Syndrome (SJS) in 1 eye (5%). Total keratolimbal allograft (KLAL) was performed in 80% eyes (16/20), sectoral KLAL in 15% eyes (3/20) and conjunctival limbal allograft (CLAL) in 5% eyes (1/20). Glaucoma was associated pre-operatively in 55% eyes. Five eyes had previous keratoplasty and 2 eyes had keratoplasty with OSST. Mean time to keratoplasty after OSST was 12.6±16.2 months (2.5-57 months). Repeat keratoplasty was required in 70.5% of eyes (12/17). Mean number of keratoplasties required after OSST was 1.95±1.3 (0-5). Mean follow-up was 148±59.1 months (19-251 months) and mean duration of systemic immunosuppression was 107.6±60.3 (6-186) months in 14 eyes. Stable ocular surface was seen in 66.6% eyes (2/3) after sectoral KLAL, 23.1% eyes (3/13) after total KLAL on systemic immunosuppressive therapy and 33% eyes (1/3) after total KLAL without systemic immunosuppressive therapy. At last visit, 10% eyes (2/20) had had Boston Keratoprosthesis (K-Pro) surgery. Repeat OSST was required in 30% eyes (6/20). Complications included recurrent epithelial defect in 14 eyes (70%), one or more episodes of graft rejection in 13 eyes (65%), increased intraocular pressure that required placement of tube shunt in 9 eyes (45%), infectious keratitis in 5 eyes (25%) and descemetocele in 2 eyes (10%).
Long-term follow-up after total OSST with systemic immunosuppression showed graft failure in 77% eyes. Multiple ocular surgeries were required in 70% eyes. Recurrent epithelial defect was the most common complication occurring in 70% eyes.
This PDF is available to Subscribers Only