Long-term outcome and prognostic factor analysis for keratolimbal allografts

To evaluate the long-term results of keratolimbal allograft (KLAL) and elucidate the prognostic factors of KLAL survival.

Twenty-four eyes of 22 patients underwent KLAL one or more times, and were followed up more than 1 year postoperatively. Their medical records were reviewed. The success of KLAL and penetrating keratoplasty (PKP) was evaluated. KLAL success was defined as absence of persistent corneal epithelial defect, corneal conjunctivalization, or neovascularization on the corneal edge of the graft. Prognostic factors for survival of KLAL were analyzed, including preoperative diagnosis, history of graft rejection, symblepharon, concurrent surgery, immunosuppressant dose, and interval for full epithelialization time. The prognostic factors were evaluated by univariate survival analysis or multivariate Cox proportional hazards survival regression.

KLAL had been successful in 33.3% of the eyes over an average of 47.9 months. Fifteen episodes of KLAL rejection developed in ten eyes (41.7%), but 13 cases (86.7%) were reversible. Of 45 KLAL procedures, eyelid deformity, symblepharon, and the interval of full epithelialization were significantly associated with KLAL success by univariate analysis, and the presence of symblepharon was identified by multivariate Cox regression analysis as the most important prognostic factor to affect KLAL outcome (p = 0.010).

KLAL has been partly successful for reconstruction of limbal stem cell deficiency, and symblepharon has been identified as a significant prognostic factor for KLAL survival. Surgical correction of symblepharon is important before KLAL and PKP.