Simultaneous penetrating keratoplasty and amniotic membrane transplantation in eyes with a history of limbal stem cell deficiency

To describe the outcomes of simultaneous penetrating keratoplasty (PK) and amniotic membrane transplantation (AMT) performed both as a ring-shaped graft and as a temporary patch in eyes with a history of limbal stem cell deficiency (LSCD). Prospective observational case series including 48 simultaneous PK/AMT procedures (48 patients) in eyes with a history of partial or total LSCD. Patients with total LSCD were first treated with limbal stem cell transplantation. The preoperative indication was graft failure in 58.3% of cases. Most recipients (89.6%) were at high-risk for rejection. The mean graft reepithelialization time was 29.2±30.8 days. Graft reepithelialization was achieved in 30 days in 70.8% of cases. No AMT-related adverse events were observed. The mean time from keratoplasty-to-last visit was 84.5±54.5 months. The 3-year graft survival rate was 62.5%. Recurrence of corneal epithelial defects after graft reepithelialization (47.9%) was associated with lower graft survival (P=0.004). In eyes with successful grafts at the last visit, the mean LogMAR visual acuity was 1.90 (20/1575)±5 lines before keratoplasty and 0.89 (20/155)±10 lines at 5 years. A ring of amniotic membrane was visible between the graft stroma and the corneal epithelium on slit-lamp examination and optical coherence tomography in all successful cases. In this series of eyes with a history of LSCD and at high-risk of rejection, simultaneous PK and AMT were associated with satisfactory graft survival and no additional adverse events. Notre but est de rapporter les résultats de la kératoplastie transfixiante (KT) combinée à une greffe de membrane amniotique (GMA) en anneau et en patch temporaire au cours du déficit en cellules souches limbiques (DCSL). Il s’agit d’une série prospective observationnelle incluant 48 chirurgies combinées KT/GMA (48 patients) réalisées dans des yeux ayant des antécédents de DCSL partiel ou total. Les patients ayant un DCSL total ont été traités préalablement par une greffe de cellules souches limbiques. L’indication de la greffe était un échec de greffe dans 58,3 % des cas. La plupart des receveurs (89,6 %) étaient à haut risque de rejet. Le temps moyen de réépithélialisation du greffon était de 29,2±30,8jours. Le greffon était réépithélialisé au cours du premier mois dans 70,8 % des cas. Aucun effet indésirable lié à la GMA n’a été observé. Le délai moyen entre la greffe et la dernière visite était de 84,5±54,5 mois. Le taux de survie du greffon à 3 ans