Long-Term Outcome After Superficial Keratectomy of the Abnormal Epithelium for Partial Limbal Stem Cell Deficiency

• Published in: American journal of ophthalmology Vol. 231; pp. 134 - 143
• Main Authors: Matsumura, Takehiro, Yamaguchi, Takefumi, Higa, Kazunari, Inatani, Masaru, Shimazaki, Jun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Antibodies; Cornea; Corneal Diseases - etiology; Corneal Diseases - surgery; Epithelium, Corneal - surgery; Humans; Inflammation; Keratectomy; Laboratories; Limbus Corneae - surgery; Medical prognosis; Medical records; Medical research; Membranes; Retrospective Studies; Stem Cell Transplantation; Stem Cells; Surgery; Surgical outcomes
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2021.05.023

•Superficial keratectomy is useful for various partial limbal stem cell deficiency.•Recurrence of the abnormal epithelium occurs in approximately one-third of cases.•Postoperative delayed epithelialization is a risk factor for recurrence.•Extensive limbal involvement is another risk factor for recurrence.•Although some cases need repeat surgeries, the final success rate is more than 80%. To investigate the etiology and long-term surgical prognosis of the abnormal epithelium for partial limbal stem cell deficiency (LSCD), following superficial keratectomy Retrospective, interventional case series This single-center, retrospective study was conducted to assess the prognosis of consecutive patients who underwent superficial keratectomy, with or without amniotic membrane transplantation (AMT), for the treatment of partial LSCD, from 2010 to 2019. We analyzed the etiologies of partial LSCD, surgical success rate, prognosis for recurrent cases, and the improvement in visual acuity. We included 40 patients (51 eyes) with partial LSCD. All eyes were in clinical stage II without dense fibrovascular tissue. Idiopathy was the most common etiology (39%), followed by multiple surgeries involving the corneoscleral limbus (19%). All eyes attained corneal reepithelialization and transparency. Furthermore, the visual acuity improved or remained unchanged postoperatively. We observed recurrence in 19 eyes (37%) with a mean follow-up period of 26.3 months. Despite no significant difference in the recurrence rates among different etiologies, postoperative delayed epithelialization and extensive limbal involvement were identified as risk factors for recurrence (P < .001 and P = .013, respectively). Repeat surgeries were performed in 16 eyes. The final success rate was 84%. Superficial keratectomy is useful for the treatment of partial LSCD of varied etiologies, with an expected improvement in visual acuity postoperatively. Although the procedure can be repeated and have a high success rate, there have been several cases of recurrence in the long-term postoperative course.