Abstract

LOPEZ-GARCIA, JS; RIVAS, L  and  GARCIA-LOZANO, I. Severe limbal deficiency treated by combined limbal allograft and amniotic membrane transplantation. Arch Soc Esp Oftalmol [online]. 2005, vol.80, n.7, pp.405-412. ISSN 0365-6691.

Purpose: To study the ocular surface evolution in patients with severe limbal deficiency treated with limbal allograft transplantation (LT) combined with amniotic membrane transplantation (AMT). Methods: We studied 14 eyes with severe limbal deficiency, treated with LT combined with AMT (LT + AMT). We studied the morphology of the limbocorneal epithelium and stroma by impression cytology and limbal biopsy. Results: Visual acuity showed a mean improvement of 0.4 at 24 months of follow-up. Corneal clarity and loss of neovascularization were markedly improved after 3 and 6 months, respectively. We did not find corneal conjuntivalization on cytology performed 6 months after surgery, except in a patient with chemical burn. Cytology and limbal biopsy performed nine months after surgery showed an epithelium and limbocorneal stroma near to normality. Squamous metaplasia was worse in patients with Stevens-Johnson syndrome and ocular cicatricial pemphigoid after 12 months, but was similar in patients with chemical burns and improved in patients with aniridia. Conclusions: LT + AMT is a very effective procedure for restoring the ocular surface integrity in patients with severe limbal deficiency. This combination improves the outcomes obtained with LT alone.

Keywords : Aniridia; biopsy; limbal deficiency; limbal transplantation; ocular cicatricial pemphigoid; severe chemical burns; Stevens-Johnson syndrome; amniotic membrane transplantation.