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Complications of Keratolimbal Allograft Surgery

Baradaran-Rafii, Alireza MD; Eslani, Medi MD; Djalillian, Ali R. MD

doi: 10.1097/ICO.0b013e31826215eb
Clinical Science

Purpose: To report postoperative complications of keratolimbal allograft (KLAL) transplantation in patients with bilateral total limbal stem cell deficiency.

Methods: In this retrospective observational case series, medical charts of 45 patients with at least 6 months of follow-up were reviewed. The main outcome measure was postoperative complications including graft-related issues (thickness, position, and alignment) and immunologic rejection.

Results: Sixty-six KLALs were performed on 45 eyes. The mean follow-up period was 26.1 ± 11.8 months (range, 6–48 months). Primary failure occurred in 5 eyes primarily as a result of ocular surface exposure and severe dry eyes. Graft-related complications included misalignment (4 eyes), buttonhole (4), inner-edge tear (4), inadvertent limbal trephination (2), and thick KLAL (2). Postoperatively, regional thinning of the graft was observed in 8 KLALs as a result of exposure, regional ischemia, and after epithelial rejection. Acute rejection was diagnosed 16 times in 8 eyes, whereas chronic rejection was observed in 24 eyes. At last follow-up, 12 cases (26.6%) had failed because of recurrent acute rejection (4), chronic rejection (5), refractory herpetic keratitis (1), exposure (1), and refractory papillomavirus keratitis (1).

Conclusions: KLAL may be complicated by several adverse events. The most important complications are immunologic rejections, chronic ocular surface exposure, and graft-related complications.

*Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL.

Reprints: Medi Eslani, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran 16666, Iran (e-mail:

The authors have no proprietary or commercial interest in any materials discussed in this article. No authors have any financial or conflicting interests to disclose.

Received January 3, 2012

Accepted May 29, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.