1. Sutureless Keratolimbal Allograft Transplantation for Ocular Surface Reconstruction Using Fibrin Glue Authors have no financial interest regarding this presentation PEJMAN BAKHTIARI MD, ALI DJALILIAN MD

2. 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.

3. 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.

4. 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)

5. Methods of Keratolimbal Blocks Preparation

6. Results • 18 patients (12 females and 6 males) with mean age of 43 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.

7. Post-operative Photos • 3 weeks and 24 months post-op photos of an aniridic patient has undergone suturless KLAL 3 weeks post-op 24 months post-op

8. 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.