Outcomes of Conjunctival-Limbal Autograft in Unilateral Total Limbal Stem Cell Deficiency

To report the outcomes of conjunctival-limbal autograft (CLAU) in patients with unilateral total limbal stem cell deficiency (LSCD) emphasizing surgical problems, complications, and their management.

In this prospective interventional case series, CLAU combined with amniotic membrane transplantation as a graft was performed on 26 patients with unilateral total LSCD due to chemical or thermal injuries. Penetrating keratoplasty (PKP) was performed on eyes with dense corneal opacification. Main outcome measures were visual acuity, corneal transparency and vascularization, and complications.

Optical PKP was performed on 18 eyes. Best spectacle-corrected visual acuity (BCVA) was 2.28±0.45 LogMAR before CLAU which improved to 0.64±0.52 LogMAR and 0.35±0.13 LogMAR at final follow-up in eyes with and without PKP, respectively. Corneal transparency and vascularization, which were graded as 4+ before surgery, improved to a mean of 1.7±0.8 and 2.1±0.7 three months after surgery. Mean epithelial healing time was 8.8±4.1 (range 5 to 20) days. Longer healing occurred in 5 eyes due to small lenticules (n=2), exposure (n=2), and conjunctival encroachment (n=1). Mean healing period for epithelial defects over PKP was 8.8±5.5 (range 4 to 14) days. Persistent epithelial defects occurred in 8 cases with cut lenticules (n=2), small-sized lenticules (n=2), and chronic exposure (n=4). Lenticule-related complications were thick lenticules (n=4), conjunctival mantle encroachment (n=2), dislodging (n=4), progressive thinning (n=2), small size (n=3), and accidental trephination (n=2).

CLAU combined with AMT with or without PKP is effective in anatomical and visual rehabilitation of eyes with unilateral total LSCD. This procedure increases corneal transparency and decreases vascularization. The lenticules should be handled carefully in order to avoid most common lenticule-related complications.