Optimizing Keratolimbal Allograft Outcomes: Optical Coherence Tomography Analysis of Donor Graft Phenotypes in Limbal Stem Cell Deficiency.

PURPOSE: To evaluate the morphology of donor grafts and limbal microstructure after keratolimbal allograft (KLAL) surgery using anterior segment optical coherence tomography (AS-OCT) and to explore the relationship between graft shape and clinical outcomes.

METHODS

This retrospective study included patients with limbal stem cell deficiency from severe ocular surface burns who underwent KLAL with or without concurrent keratoplasty. AS-OCT was used to assess graft morphology and the graft-recipient interface. Grafts were classified into 3 types-wedge-shaped, trapezoidal, and irregular-shaped-based on AS-OCT imaging. Postoperative clinical outcomes, including neovascularization, conjunctivalization, and corneal opacity, were recorded and compared across graft types.

RESULTS

Among 26 eyes from 23 patients, wedge-shaped grafts showed significantly higher success rates, with fewer complications of neovascularization, conjunctivalization, and corneal opacity, compared with trapezoidal and irregular-shaped grafts. Specifically, wedge-shaped grafts had superior outcomes in neovascularization (vs. trapezoidal: χ 2 = 5.658, P = 0.017; vs. irregular: χ 2 = 6.062, P = 0.014), conjunctivalization (vs. trapezoidal: χ 2 = 5.855, P = 0.016; vs. irregular: χ 2 = 6.814, P = 0.009), and corneal opacity (vs. trapezoidal: χ 2 = 7.088, P = 0.008). AS-OCT imaging showed closer adherence of wedge-shaped grafts to the recipient bed, potentially enhancing stability, whereas trapezoidal and irregular-shaped grafts exhibited gaps that may hinder attachment.

CONCLUSIONS

AS-OCT imaging effectively visualizes donor graft morphology and graft-recipient microstructure, providing insights into KLAL outcomes. Wedge-shaped grafts, which align more closely with natural limbal anatomy, show greater ocular surface stability.