Corticosteroid-Sparing Systemic Immunosuppression for Ocular Surface Stem Cell Transplantation.

PURPOSE: The goal of our study was to highlight the results of a corticosteroid-sparing immunosuppressive regimen for patients with limbal stem cell deficiency (LSCD) undergoing ocular surface stem cell transplantation (OSST). METHODS: This retrospective review studied patients with LSCD undergoing OSST from 2014 to 2023, evaluating the evolving corticosteroid-sparing systemic immunosuppression regimen over time. Inclusion criteria encompassed patients aged 18 to 69 with total/near-total LSCD that underwent OSST and were treated postoperatively with oral corticosteroids. Outcomes included ocular surface stability, visual acuity, and rates of rejection/failure. Corticosteroid dosage, taper length, and corticosteroid-related side effects were recorded. RESULTS: There were 166 eyes that met the inclusion criteria. The mean starting dose of prednisone was 34.5 mg (range: 30-60), with a mean taper length of 13.3 weeks (range: 3-59 weeks). There were 66 eyes that underwent a keratolimbal allograft, 96 eyes that underwent a living-related conjunctival limbal allograft, and 28 eyes that underwent a conjunctival limbal autograft. At the last follow-up, 72.3% of eyes had a stable ocular surface and 60.2% had visual improvement of at least 2 lines. Approximately 19.9% of eyes developed rejection and 13.3% developed failure during the follow-up period. CONCLUSIONS: A modified corticosteroid-sparing immunosuppression protocol for OSST has shown significant efficacy in restoring the ocular surface of patients with LSCD. A corticosteroid-sparing immunosuppressive regimen mitigates the side effects related to oral corticosteroid usage, without compromising the stability of the stem cell graft.