Outcome of Allogeneic Penetrating Limbo-Keratoplasty: A Single-Center Retrospective Cohort Study

<b>Introduction:</b> Allogeneic penetrating limbo-keratoplasty (limbo-PK) is one of the surgical methods for the treatment of limbal stem cell deficiency (LSCD). We report real-life results on different entities. <b>Methods</b>: Patients treated with limbo-PK at the Department of Ophthalmology of the University Medical Center Mainz were evaluated retrospectively. The primary endpoint was the epithelialization of the graft one year postoperatively. In addition, the postoperative best corrected visual acuity (BCVA), ocular concomitant diseases, drug treatment, and the need for further eye surgery postoperatively were examined. <b>Results</b>: We included 14 eyes of 13 patients (4 female) aged 59.8 ± 14.1 years who underwent limbo-PK between 2020 and 2024. Indications for limbo-PK included chemical burns (<i>n</i> = 4), blast injuries (<i>n</i> = 4), thermal burns (<i>n</i> = 2), trauma (<i>n</i> = 1) graft-versus-host disease (<i>n</i> = 1), and ectrodactyly-ectodermal dysplasia (EEC) (<i>n</i> = 1). The mean preoperative BCVA was 2.2 ± 0.6 logMAR (range: light perception to 0.7 logMAR). Four limbo-PK-grafts were HLA-typed. All limbo-PKs were combined with amniotic membrane transplantation; three with cataract surgery and one with tarsorrhaphy. Postoperatively, all patients received local immunosuppression, and 12 (85.7%) received additional systemic immunosuppression. At one-year follow-up mean BCVA increased to 1.0 ± 0.7 logMAR (range: 2.3 to 0.1, <i>p</i>-value = 0.03) and 11 of 14 eyes showed a functional graft with closed epithelium. In the further postoperative course, four patients needed a further Limbo-PK due to graft failure (<i>n</i> = 2), immune graft rejection after stopping local immunosuppressive therapy (<i>n</i> = 1) and perforation of the graft in a severe case of GvHd (<i>n</i> = 1). <b>Conclusions</b>: Limbo-PK is an effective surgical method for the treatment of LSCD. In our study cohort, we observed a significant improvement in mean BCVA one year postoperatively, with a functional, epithelialized graft achieved in 11 of 14 eyes.