Corticosteroid-Sparing Systemic Immunosuppression for Ocular Surface Stem Cell Transplantation

The goal of our study was to highlight the results of a corticosteroid-sparing immunosuppressive regimen for patients with limbal stem cell deficiency (LSCD) undergoing ocular surface stem cell transplantation (OSST).

This retrospective review studied patients with LSCD undergoing OSST from 2014 to 2023, evaluating the evolving corticosteroid-sparing systemic immunosuppression regimen over time. Inclusion criteria encompassed patients aged 18 to 69 with total/near-total LSCD that underwent OSST and were treated postoperatively with oral corticosteroids. Outcomes included ocular surface stability, visual acuity, and rates of rejection/failure. Corticosteroid dosage, taper length, and corticosteroid-related side effects were recorded.

There were 166 eyes that met the inclusion criteria. The mean starting dose of prednisone was 34.5 mg (range: 30-60), with a mean taper length of 13.3 weeks (range: 3-59 weeks). There were 66 eyes that underwent a keratolimbal allograft, 96 eyes that underwent a living-related conjunctival limbal allograft, and 28 eyes that underwent a conjunctival limbal autograft. At the last follow-up, 72.3% of eyes had a stable ocular surface and 60.2% had visual improvement of at least 2 lines. Approximately 19.9% of eyes developed rejection and 13.3% developed failure during the follow-up period.

A modified corticosteroid-sparing immunosuppression protocol for OSST has shown significant efficacy in restoring the ocular surface of patients with LSCD. A corticosteroid-sparing immunosuppressive regimen mitigates the side effects related to oral corticosteroid usage, without compromising the stability of the stem cell graft.