What is the difference between keratolimbal allograft and autologous graft

Herein, we noted that such epithelial breakdown still developed late after PKP in 9 of 12 eyes despite all aforementioned measures. A continuous follow-up to protect against any insult to the ocular surface cannot be overstated. Such conventional measures as punctal occlusion, artificial tears, and autologous serum drops were not sufficient.

Extended bandage contact lens wear not only protected the eye from blink-related microtrauma during blinking, but also held a stable precorneal tear film in eyes with infrequent blink. We did not note any bandage contact lens—associated infectious keratitis during the entire follow-up, when eyes also received topical antibiotic eye drops only during epithelialization and daily irrigation with preservative-free saline.

The remaining exposure problem due to increased scleral show was solved by permanent tarsorrhaphy, while problems due to lagophthalmos were solved by other reconstructive operations. As a result, 7 of 9 eyes with epithelial breakdown healed and maintained a stable corneal epithelium and helped improve the surgical outcome. Combined immunosuppressive agents also play a role in our long-term maintenance of a clear and functional graft.

Before KLAL, patients had their routine check-ups with an internist to rule out underlying diseases, such as significant hypertension, liver or kidney dysfunction, and hematocytopenia, all of which may affect the use and dosage of systemic immunosuppressants.

During immunosuppressant treatment, internists and transplant specialists were consulted if there was any issue related to toxicity. The goal of immunosuppression is to keep the eye uninflamed, which the ophthalmologist monitors to avoid systemic adverse effects, which are monitored by an internist. Indeed, 4 such episodes were reversed after adjusting immunosuppressant doses and correcting the remaining ocular surface deficits.

It is likely that previous failed KLALs in eyes with the highest risk scores decreased the success rate of subsequent KLALs despite adnexal surgery, corrective measures, and strong immunosuppression. Future studies are needed to address this likelihood and to determine whether these eyes require a different immunosuppressive regimen.

Future studies with a larger sample size may help determine the relative importance between measures taken to correct different ocular surface deficits in various ocular surface diseases and the combined immunosuppressive regimen in attaining the long-term success of KLAL with or without PKP in eyes with total LSCD caused by different diseases.

Correspondence: Scheffer C. Submitted for Publication: January 10, ; final revision received March 24, ; accepted March 30, No other author has any proprietary interest in any material mentioned in this study. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Figure 1. View Large Download. Table 1. Preoperative Clinical Characteristics and Risk Factors.

Schermer AGalvin SSun T-T Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells.

Daya SMIlari L Living related conjunctival limbal allograft for the treatment of stem cell deficiency. Holland EJ Epithelial transplantation for the management of severe ocular surface disease.

Hill JC Systemic cyclosporine in high-risk keratoplasty: short- versus long-term therapy. Treatment of severe ocular surface disorders with corneal epithelial stem-cell transplantation.

Ilari LDaya SM Long-term outcomes of keratolimbal allograft for the treatment of severe ocular surface disorders. Long-term outcome of keratolimbal allograft with or without penetrating keratoplasty for total limbal stem cell deficiency.

Tabbara KF Pharmacologic strategies in the prevention and treatment of corneal transplant rejection. Holland EJSchwartz GS The evolution of epithelial transplantation for severe ocular surface disease and a proposed classification system. Prabhasawat PTseng SCG Impression cytology study of epithelial phenotype of ocular surface reconstructed by preserved human amniotic membrane. Cher I Blink-related microtrauma: when the ocular surface harms itself. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation.

Ayyala RS Penetrating keratoplasty and glaucoma. Leukopenia in kidney transplant patients with the association of valganciclovir and mycophenolate mofetil. Immunosuppression with generic tacrolimus and mycophenolate mofetil in renal transplant recipients: preliminary report in Chile.

Ocular surface transplant recipients experience minimal immunosuppression complications: implications for composite tissue transplants [abstract]. Am J Transplant ; Google Scholar.

Traditional conjunctival autografts and conjunctival limbal autografts The conjunctival limbal autograft CLAU procedure was one of the first curative techniques to be described for LSCD. Living-related conjunctival—limbal allograft Kwitko et al 25 were the first to use conjunctival tissue from a living relative parent or sibling to manage LSCD in the procedure that is now known as living-related conjunctival allograft Ir-CAL , which was then modified to include limbus along with conjunctiva Ir-CLAL.

Cadaveric keratolimbal allografts The keratolimbal allograft KLAL procedure uses cadaveric limbal tissue as the source of limbal stem cells, which thus allows for a larger stem cell supply. Autologous ex vivo cultivated limbal epithelial transplantation Though the concept of cultured epithelial stem cell-based therapy was developed in the s, 43 this technique was not applied for the treatment of ocular surface disease until by Pellegrini et al. Simple limbal epithelial transplantation In , Sangwan et al 60 introduced simple limbal epithelial transplantation SLET as an alternative to CLET, a novel approach that achieves in vivo expansion of harvested limbal stem cells.

Figure 4. Simple limbal epithelial transplantation. Cultivated oral mucosal epithelial transplantation In the cultivated oral mucosal epithelial transplantation COMET technique, reconstruction of the ocular surface relies on the autologous epithelium of oral mucosal, rather than ocular, origin.

Limbal stem cell transplantation and secondary keratoplasty The primary goal of limbal stem cell transplantation is to restore a stable ocular surface. Figure 5. Combined penetrating keratoplasty and simple limbal epithelial transplantation.

Conclusion In the past 3 decades, significant progress has been made in understanding the physiology of the limbal epithelial stem cells and their key role in maintaining corneal transparency. Footnotes Disclosure The authors report no conflicts of interest in this work.

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What is Autologous Graft 5. Limbal stem cell deficiency is a disease condition arising due to destruction of the limbal epithelial stem cells. It can mainly occur due to chemical injury or impairment of the development.

Limbal stem cell deficiency is responsible for decreased vision, pain and impaired quality of life. Limbal stem cell transplantation is the main surgical treatment for limbal stem cell deficiency. There are several limbal stem cell transplantation procedures.

Keratolimbal allograft and autologous graft are two techniques are two among them. Keratolimbal allograft is a technique that uses cadaveric limbal stem cells to treat a patient with a limbal stem cell deficiency. This surgery is done when there is no available or willing relative to donate limbal stem cells for stem cell transplantation.

Hence, this procedure utilizes the allogenic tissue for the transplantation. Keratolimbal allograft is a promising surgery for bilateral or total stem cell deficiency.

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