Long-term outcomes of keratolimbal allograft for the treatment of severe ocular surface disorders

Purpose: To investigate the long-term outcome of keratolimbal allograft (KLAL) for the treatment of severe ocular surface disorders. Design: Retrospective, noncomparative case series. Participants: Twenty patients (23 eyes) with severe ocular surface disorders. Intervention: Thirty-three KLAL procedures were performed. Ten patients (10 eyes) underwent KLAL in combination with other surgical procedures. Oral or topical cyclosporine or both were used after surgery in 15 patients to prevent allograft rejection. Main Outcome Measures: Reconstruction of the ocular surface with restoration of phenotypic corneal epithelium, reduction of corneal vascularization and conjunctivalization, decreased pain, and visual improvement. Results: The mean follow-up was 60 months (range, 15-96 months). Eight eyes (24.2%) never reepithelialized and were considered primary failures. The remaining 25 grafts initially restored a phenotypic corneal epithelium, but at last follow-up only 7 (21.2%) were stable. Graft survival rate was 54.4% at 1 year, 33.3% at 2 years, and 27.3% at 3 years. Visual acuity improved or was unchanged in 19 eyes (82.6%) and decreased in 4 eyes (17.4%). Seventeen corneal transplantations (3 lamellar keratoplasties and 14 penetrating keratoplasties) were performed either in combination with or after a KLAL. All three lamellar keratoplasties were successful, whereas 13 of the 14 penetrating keratoplasties failed. Cyclosporine was used initially in high-risk recipients and later in all recipients. Allograft rejection episodes occurred in 13 KLAL procedures of 11 eyes (39.4%) and were more common in patients treated with cyclosporine compared with the untreated group (87.5% vs. 22.2%). Graft survival was longer in the cyclosporine-treated group compared with the untreated group. Conclusions: Keratolimbal allograft is useful in ocular surface reconstruction and restores phenotypic corneal epithelium. Graft survival rate, however, decreases dramatically over a 2-year period. Long-term use of cyclosporine appears to prolong graft survival but does not prevent acute allograft rejections. Ophthalmology 2002,109:1278-1284 (C) 2002 by the American Academy of Ophthalmology.