Sludging: A Postoperative Clinical Finding After Ocular Surface Stem Cell Transplantation

Area of Science:

• Ophthalmology
• Regenerative Medicine
• Transplantation Science

Background:

• Ocular surface stem cell transplantation (OSST) aims to restore vision in severe limbal stem cell deficiency.
• Postoperative complications can impact graft survival and visual outcomes.
• Distinguishing benign findings from rejection is crucial for appropriate management.

Purpose of the Study:

• To describe the clinical characteristics of a postoperative finding termed "sludging" after OSST.
• To identify risk factors associated with sludging.
• To evaluate the impact of sludging on OSST graft outcomes.

Main Methods:

• Retrospective review of 261 eyes from 196 patients who underwent OSST.
• Data collection included patient/donor demographics and clinical outcomes.
• Analysis of sludging prevalence, timing, resolution, and association with graft outcomes.

Main Results:

• Sludging, characterized by dilated graft vessels without inflammation, occurred in 29.5% of eyes.
• It appeared a mean of 1.31 years post-OSST and resolved in 70.1% of cases.
• Sludging was more frequent after keratolimbal allograft (KLAL) and associated with increased graft rejection and failure rates.

Conclusions:

• Sludging is a distinct noninflammatory postoperative finding in OSST, especially after KLAL.
• Recognizing sludging is vital to differentiate it from acute graft rejection.
• Management and prognosis differ between sludging and rejection, necessitating accurate diagnosis.