Therapeutic Options for Patients with Bilateral Limbal Stem Cell Deficiency

Purpose: Live-related conjunctival-limbal allografting (Lr-CLAL), allogeneic cultivated limbal epithelial transplantation (allo-CLET). autologous cultivated oral mucosal epithelial transplantation (COMET) and Boston Type 1 Keratoprosthesis (Boston Kpro) are the four most widely performed procedures for patients with bilateral limbal stem cell deficiency (LSCD) with wet ocular surfaces. This study aimed to compare the visual outcomes of the various treatment modalities for bilateral LSCD. Methods: This was a retrospective analysis of a single surgeon’s clinical experience of treating 62 eyes of 50 patients with bilateral LSCD with wet ocular surface, over a period of ten years(2001 to 2011). The primary outcome measures were best post-operative best corrected visual acuity(BCVA) achieved and duration for which it was maintained. Results: Although mean pre-operative BCVA was comparable among the four groups(Lr-CLAL n=11, allo-CLET n=31, COMET n=13, Boston Kpro n=30) (P=0. 07), post-operatively statistically significant improvement in mean BCVA was seen only after alloCLET (0. 9 logmar. P=0. 0002) and Boston Kpro (1.5 logmar. P<0. 0001). Mean post-op BCVA decreased after COMET, although it was not statistically significant (P=0. 56). Duration for which best BCVA was maintained was similar among all groups (P=0.1). When compared head to head, proportion of patients achieving 20/200 or better vision was higher after Boston Kpro(P=0.03) as compared to allo-CLET although the duration for maintaining the same was not significantly different (0.12). Conclusions: Best post-operative BCVA attained by eyes treated for bilateral LSCD was significantly better after Boston Kpro implantation and this was maintained for as long as that following the other treatment modalities.