Surgical Treatment of Total Bilateral LSCD using a Keratolimbal Allograft (KLAL) and Amniotic Membrane Transplantation (AMT)

Bilateral total LSCD treated with superficial keratectomy AMT & KLAL
          Before treatment                      After treatment

Surgical Steps for Treating Bilateral LSCD using KLAL and AMT:

  1. Perform limbal peritomy
  2. Remove the corneal pannus via blunt superficial keratectomy
  3. Polish the corneal surface with a dental burr (only if uneven).
  4. Perform amniotic membrane transplantation using fibrin glue to cover the affected corneal surface and the bare sclera (as a Permanent graft - which allows the host cells to proliferate over the membrane). Spare the visual axis if the remaining corneal stroma is smooth and clear centrally by opening a 6 mm diameter window on AM.
  5. Harvest a Keratolimbal allograft (KLAL) from a cadaveric donor and including 360° of the limbus, with 2-3 mm of peripheral cornea (obtained by a 7.5 to 8.0 mm trephine) and 0 to 5 mm of the sclera (depending the need for scleral repair or not).
  6. Secure this free KLAL graft to the limbal area of the affected eye by interrupted 10-0 nylon sutures from the donor scleral edge to the recipient sclera (16 to 20 bites) through the underlying AM.
  7. Insert PROKERA® to cover the cornea and the limbal graft (as Temporary patch graft). The benefits of cryopreserved amniotic membrane will be delivered through this sutureless conformer ring, which protects the cornea and the graft from external trauma and while exerting biologic functions to all covered parts of the ocular surface.

Click here to view a video showing the surgical treatment of Total Bilateral LSCD using KLAL and AMT.


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