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Outcomes of penetrating keratoplasty following autologous cultivated limbal epithelial stem cell transplantation

Lookup NU author(s): Dr Gustavo Figueiredo, Dr Oliver Baylis, Professor Majlinda LakoORCiD, Professor Francisco FigueiredoORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Purpose: To investigate the outcomes of penetrating keratoplasty (PKP) following autologous cultivated limbal epithelial stem cell transplantation (CLET).Methods: A prospective, single centre, interventional cohort study investigating patients with unilateral total limbal stem cell deficiency (LSCD) treated with CLET who underwent PKP. Patients with confirmed corneal re-epithelialization > 6 months post-CLET, and with best-corrected visual acuity (BCVA) <0.3 logMAR were offered PKP. Outcome measures: CLET survival assessed by slit lamp, corneal impression cytology (CIC) and in vivo confocal microscopy (IVCM). Confirmation of corneal re-epithelialization by histological and immunocytochemical (ICC) examination of trephined corneal buttons. Mean change in best-corrected visual acuity (logMAR) following PKP and PKP survival at 12 months were calculated.Results: 20 patients underwent PKP. Mean time of PKP was 19 months (range 11–41 months, SD 7.26) post-CLET. Median follow-up time post-PKP was 15.0 months (range 1–32, SD 10.2). CIC and ICC of all corneas confirmed corneal re-epithelialization before PKP. Mean pre-PKP BCVA was 1.46 (range 0.3–2.7, SD 0.94) improving to a mean post-PKP BCVA of 0.74 (range 0–2.7, SD 0.87); mean improvement in BCVA post-PKP of 36 letters (95% CI 15.0-57.1, p=0.002). Kaplan-Meier mean graft survival was 90.9% (95% CI 50.8-98.7) at 12 months.Conclusions: We recommend a two-stage approach with CLET followed by PKP >12 months later. Patients experienced a significant improvement in BCVA following PKP. PKP did not have a detrimental effect on CLET survival. PKP survival post-CLET is better than that reported for high risk PKP.

Publication metadata

Author(s): Figueiredo GS, Salvador CB, Baylis O, Hardeep M, Lako M, Figueiredo FC

Publication type: Article

Publication status: Published

Journal: Stem Cells

Year: 2018

Volume: 36

Issue: 6

Pages: 925-931

Print publication date: 01/06/2018

Online publication date: 13/02/2018

Acceptance date: 05/02/2018

Date deposited: 01/02/2019

ISSN (print): 1066-5099

ISSN (electronic): 1549-4918

Publisher: AlphaMed Press Inc.


DOI: 10.1002/stem.2803


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Funder referenceFunder name
G0900879Medical Research Council (MRC)