Timeframe to Keratoplasty After Ocular Surface Stem Cell Transplantation.

Purpose: The aim of this study is to report the actual time delay between ocular surface stem cell transplantation (OSST) and keratoplasty at a high-volume center for limbal stem cell deficiency (LSCD). Understanding expected timelines and reasons for any delays or deferrals can allow for more accurate expectation-setting discussions with prospective patients.

Methods: A retrospective chart review was performed on all patients having undergone OSST between January 2013 and December 2022. Charts were reviewed to determine whether the need for keratoplasty was specified at the time of OSST planning. Parameters for these cases were then collected including underlying diagnoses, type of OSST performed, and time delay between OSST and keratoplasty (if performed). Results were then aggregated, and subgroup analysis was conducted.

Results: A total of 219 eyes were included, of which, 128 eyes had initial intent for keratoplasty. Of these, 48% had keratoplasty within 6 months of OSST, 17% between 6 and 24 months, 5% beyond 2 years, and, interestingly, 30% had no subsequent keratoplasty. Most eyes with no eventual keratoplasty experienced unanticipated stromal clearing after OSST obviating the need for keratoplasty.

Conclusions: This is the first study to report realized time delay between OSST and keratoplasty at a large LSCD practice. Prospective patients can be counselled that 76% of compliant cases with initial intent for keratoplasty either had keratoplasty within 6 months or exhibited unanticipated stromal clearing after OSST alone. Patients with congenital aniridia or contact lens-related LSCD are more likely to have unanticipated stromal clearing.