Abstract

SA.09.12

Two-year results of penetrating high risk keratoplasty after cultivated limbal epithelium transplantation (CLT)

Nina Niederdräing, Melissa Thanos, Mikk Pauklin, Henrike Westekemper, Raid Darawsha, Klaus-Peter Steuhl, Daniel Meller
Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen

Objective
Limbal stem cell deficiency caused for example by chemical or thermal burns represents a high risk of corneal graft rejection. We describe our results of penetrating keratoplasty (pKP) in patients who previously/simultaneously underwent transplantation of cultivated limbal epithelium transplantation (CLT) on amniotic membrane.
Methods
In a noncomparative interventional case series 11 eyes from 10 patients (m:f  3:7; mean age at surgery 42.1 years (y), range 26 to 74 y) were included. Seven eyes received a contralateral-autologous CLT. Four eyes underwent allogenic CLT. In 3 eyes, PKP was performed simultaneously, in eight eyes, PKP was performed in average 8.4 months (m) (range 7 to 21 m) after CLT. Additionally, all patients got pre- or postoperatively subconjunctival (s.c.) Avastin injections. The patients were examined on a regular basis.
Results
Mean follow up period was 25.7 ± 8.3 m (range 15 to 38 m) after CLT and 17.5 ± 8.8 m (range 4 to 35 m) after PKP.Please insert your textA stable ocular surface was achieved in 8 eyes (73%). Three eyes (27%) showed a peripheral vascularization and an unstable epithelium. The average visual acuity (VA) improved significantly from preoperative hand motion (0.005) to postoperative 0.2 (p<0.0001). The VA increased in 9 eyes (82%), was stable in 1 eye (9%) and worsened in another eye (9%). Acute corneal graft rejection was found in 2 eyes of 2 patients receiving autologous CLT, which could be treated successfully with fortified immunosuppression. Chronic corneal and limbal graft failure/rejection were additionally noted in 2 eyes of one patient during the follow-up period.
Conclusions
Combination of autologous or allogenic CLT followed by penetrating keratoplasty leads to an increased visual acuity and better quality of life. After additional pKP systemic immunosupression is recommended in all cases for a minimum of 6 to 12 months.

Copyright: 2009 Porstmann Kongresse GmbH. All rights reserved. Impressum, Disclaimer.