Clinical Outcomes of Keratolimbal Allograft Transplantation With Oral Mucosal Transplantation for Limbal Stem Cell Deficiency With Symblepharon

<b>Objective:</b> To report preliminary clinical outcomes of keratolimbal allograft (KLAL) transplantation with oral mucosal transplantation (OMT) for the treatment of limbal stem cell deficiency (LSCD) with symblepharon. <b>Methods:</b> This is a retrospective review of patients with LSCD and symblepharon who underwent KLAL transplantation with OMT at the Department of Ophthalmology, the Capital Medical University of Beijing Tongren Hospital between 2022 and 2024. Patients with at least 3 months of postoperative follow-up and adequate pre or postoperative records were enrolled. Grades of symblepharon, corneal conjunctivalisation, vascularization, opacification, fornix depth, and best corrected visual acuity (BCVA) were evaluated preoperatively and postoperatively. In five cases, in vivo confocal microscopy (IVCM), impression cytology (IC), and immunofluorescence (IF) were performed. <b>Results:</b> At a postoperative follow-up of 8.27 ± 5.80 months (3-22 months), 10 of 11 eyes (90.91%) maintained a successful outcome. The grades of symblepharon, corneal conjunctivalisation, vascularization, and opacification were significantly improved after surgery (<i>p</i> ≤ 0.01). Significant deepening of the fornix depth in the superior (<i>p</i> ≤ 0.01) and inferior conjunctival (<i>p</i> ≤ 0.05). Two-line improvement in BCVA was seen in 8 eyes (72.73%). Recurrence of LSCD occurred in 1 eye (9.09%). Morphology and structure of corneal epithelial cells and epithelial transition around the KLAL segments were detected by IVCM, IC, and IF. <b>Conclusions:</b> From the preliminary clinical results, KLAL with OMT is a safe and effective surgical technique for LSCD with symblepharon, maintaining epithelial stability, and restoring the patient's ocular anatomy.