Transcript Sutureless Limbal Transplantation Using Fibrin Glue

Sutureless Keratolimbal Allograft
Transplantation for Ocular Surface
Reconstruction Using Fibrin Glue
PEJMAN BAKHTIARI MD, ALI DJALILIAN MD
Authors have no financial interest regarding this presentation
Purpose
 To present method and describe visual and
anatomic outcomes of sutureless keratolimbal
allograft (KLAL) and conjunctivolimbal
autograft (CLAU) for oclular surface
reconstruction using fibrin glue.
Methods
 21 eyes of 18 consecutive patients with total
limbal stem cell deficiency (LSCD) underwent
surgery under local anesthesia.
 First 360 degrees peritomy was done followed
by scar excision and removal. Then superficial
keratectomy performed to remove
conjunctivalized pannus over the cornea.
 Trimmed thin blocks of gafts were secured
using Tisseel fibrin glue.
Methods
 Two globes of the same donor were requested.
 3 trimmed semilimbal blocks were prepared
and transplanted using fibrin glue, each
covered 120 degrees of recipients limbus
(following picture)
Methods of Keratolimbal Blocks
Preparation
Results
 18 patients (12 females and 6 males) with mean age of 43
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year-old were underwent surgery. For 18 eye KLAL and for 3
CLAU were performed with mean follow-up of 14.9 months
(range: 3-32 months) and all allografts received systemic
immunosuppression including prednisone, prograf and cellcept
Mean visual acuity increased from 20/500 to 20/155 (p=0.001)
15 (78.9%) cases showing an improvement of ≥ 2 snellen
lines.
Minimal displacement of less than one mm was noted in 6
eyes, with no functional consequence.
6 eyes experienced graft rejection; 5 of them required
penetrating keratoplasty and the other one received
keratoprosthesis.
In remaining 15 eyes corneal surface successfully
epithelialized.
Post-operative Photos
 3 weeks and 24 months
3 weeks post-op
post-op photos of an
aniridic patient has
undergone suturless
KLAL
24 months post-op
Conclusion
 KLAL and CLAU can successfully be done
using fibrin glue to secure the graft with good
anatomic and functional outcomes.
 Sutureless surgery could provide smoother
surface and improve patient comfort intra and
post-operatively.