J Korean Ophthalmol Soc.  2015 Mar;56(3):432-437. 10.3341/jkos.2015.56.3.432.

A Two Case of 360 Degree Keratolimbal Allograft

• Kim HK
• Cho KJ

• KMID: 2339051
• DOI: http://doi.org/10.3341/jkos.2015.56.3.432

Abstract

PURPOSE
To report the clinical outcomes of 360-degree keratolimbal allograft in 2 patients.
CASE SUMMARY
An 83-year-old female who had uncontrolled Mooren's ulcer invading 360 degrees of the limbus with corneal opacity received a 360-degree keratolimbal allograft (KLAL). Another 63-year-old female who had central corneal opacity and corneal neovascularization due to severe limbal cell deficiency with chemical injury received a 360-degree KLAL. During the average 17.5 months of follow-up, both eyes were tectonically maintained without severe graft rejection.
CONCLUSIONS
A 360-degree KLAL may be an effective tectonic procedure for corneal opacity caused by limbal stem cell deficiency. Herein, we report 2 cases of successfully performed 360-degree KLAL with a literature review.

Keyword

Chemical injury; Keratolimbal allograft; Limbal stem cell deficiency; Mooren's ulcer

MeSH Terms

Aged, 80 and over
Allografts*
Corneal Neovascularization
Corneal Opacity
Female
Follow-Up Studies
Graft Rejection
Humans
Middle Aged
Stem Cells
Ulcer

Figure

• 

  Figure 1. Slit lamp photograph shows a 83-year-old female with Mooren’s ulceration. (A) Peripheral corneal ulceration involving 360-degree limbus with accompanying corneal opacity was noted. (B) 1 day after surgery, well adapted keratolimbal allograft was noted. (C, D) 6 months after sugery, there was no signs of graft failure and corneal transparency was maintained. 19 months after surgery, inferior corneal thinning (blue arrow) occurred at 6 months after surgery but remained stable (red arrow). Visual improvement from hand-motion to 0.3 (best corrected visual acuity) was noted.

• 

  Figure 2. Slit lamp photograph shows a 63-year-old female who has severe limbal cell deficiency after chemical burn injury of the cornea. (A, B) Peripheral corneal neovascularization involving 360-degree and central corneal epithelial defects and opacity were noted. (C) 1 day after surgery, well adapted keratolimbal allograft was noted. (D) 10 months after sugery, there was no sign of graft failure and corneal transparency was maintained. Visual improvement from 0.02 to 0.6 (best corrected visual acuity) was noted.

• 

  Figure 3. Schematic diagram of keratolimbal allograft procedure. Donor’s keratolimbal allograft lenticules are provided from 2 cadaver corneoscleral rims with the central cornea removed by trephination (C). Posterior part (2/3 thickness) of keratolimbal allograft lenticules (grey area) are removed (B). Conjunctival peritomy for 360 degrees and ten-ectomy is performed and the conjunctival recession is performed on the recipient. Abnormal corneal epithelium and abnormal recipient keratolimbal area (anterior 1/3 thickness) are removed. Keratolimbal lenticules (blank arrow) are secured to the recipient limbus using 10-0 nylon interrupted sutures (A, C). After applying therapeutic lens to the cornea, operation is done.

Reference

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