Eversight’s most recent webinar convened two leading corneal specialists, Drs. Nambi Nallasamy and Edward Holland, for an in-depth discussion on the management of complex limbal stem cell deficiency (LSCD) cases. Their presentation explored the integration of KLAL-Pro, an eye bank–processed keratolimbal allograft (KLAL) tissue, as part of a comprehensive approach to ocular surface reconstruction and long-term patient care.
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Understanding the clinical landscape of LSCD
Limbal stem cell deficiency presents one of the most formidable challenges in corneal and ocular surface disease management. Both experts emphasized the multifactorial etiology of LSCD—from chemical injury and Stevens-Johnson syndrome to congenital aniridia and chronic inflammatory disorders—and the need for precision in diagnosis to guide surgical planning. Accurate differentiation between partial and total LSCD remains foundational to selecting appropriate interventions and predicting outcomes.
Advancements in KLAL-Pro tissue processing
A key focus of the session was the evolution of KLAL-Pro, a pre-processed, pre-sized allograft tissue prepared by Eversight. This innovation aims to standardize keratolimbal allograft (KLAL) surgery and reduce intraoperative variability.
“Standardized allograft preparation allows us to focus on the finer aspects of ocular surface reconstruction, improving efficiency and consistency in LSCD management.” —Nambi Nallasamy, MD
The presenters outlined how KLAL-Pro maintains structural integrity while minimizing handling time in the operating room. Streamlined tissue preparation contributes to surgical efficiency and consistency, enabling surgeons to focus on precise limbal placement and host integration.
Eye bank processing protocols directly impact postoperative outcomes and quality assurance.
Surgical approach & postoperative management
Both clinicians reviewed key principles of KLAL surgery, including ocular surface preparation, graft orientation and secure suture technique. Postoperative care is often more demanding than the surgery itself, requiring sustained control of inflammation, ocular surface lubrication and tailored immunosuppression.
Systemic immunosuppressive therapy—often including corticosteroids, calcineurin inhibitors or antimetabolites—is essential for allograft survival. Collaboration among ophthalmologists, rheumatologists and transplant specialists further improves outcomes.
Using KLAL-Pro in conjunction with established protocols—such as the Cincinnati Protocol previously described by Dr. Holland, utilizing contralateral eye or living related conjunctival limbal grafts (CLAU or lr-CLAL)—has yielded positive results thus far and can potentially make this treatment option more accessible for surgeons.
Integrating KLAL-Pro into comprehensive LSCD management
KLAL-Pro represents a convergence of surgical innovation and eye banking advancement. Its consistent preparation, reduced handling and optimized limbal stem cell viability align with the broader movement toward reproducible surgical outcomes.
“KLAL-Pro reflects how eye banking innovation can transform surgical reproducibility and patient outcomes.” —Edward J. Holland, MD
For patients with bilateral total LSCD or previous graft failure, KLAL-Pro may serve as a key element of a multi-stage strategy involving amniotic membrane transplantation, oral mucosal grafting or future cell-based therapies. The technology may expand access by lowering the technical barriers to performing KLAL, particularly for centers without on-site processing capabilities.
Looking ahead
The discussion closed with an optimistic look toward next-generation ocular surface therapies, including cultivated limbal epithelial transplantation and bioengineered graft materials. Both speakers underscored the importance of continued collaboration between surgeons and eye banks to refine tissue processing, improve postoperative outcomes and enhance accessibility for patients with severe LSCD.
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About the author
Michael Szkarlat
Partner Development Director
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Michael has been with Eversight since 2016 and has recently worked to develop Eversight's educational wet lab programs for EK surgery and a standardized protocol for DALK practice in a wet lab setting. His eye banking experience is rooted in the preparation of corneal grafts and spent nearly five years as Eversight’s Medical Director designee in charge of training clinical team members to prepare corneal tissue for DMEK and DSAEK surgery. In his time at Eversight, Michael has presented at scientific conferences, been involved in clinical research and developed innovations in tissue processing. He was named an IAPB Eye Heath Hero in the innovations category. Michael is passionate about community-based eye banking and honoring the precious gift that is donation. When not at work, he enjoys traveling and baking artisan sourdough bread.