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: χ2 = 5.658, P = 0.017; vs. irregular: χ2 = 6.062, P = 0.014), conjunctivalization (vs. trapezoidal: χ2 = 5.855, P = 0.016; vs. irregular: χ2 = 6.814, P = 0.009), and corneal opacity (vs. trapezoidal: χ2 = 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.