[Amniotic membrane transplantation with or without limbal allografts in corneal surface reconstruction in limbal deficiency].
OBJECTIVE
We examined whether amniotic membrane transplantation (AMT) is useful in preparing the perilimbal stroma to enhance the success of allograft limbal transplantation (ALT).


METHODS
Forty-seven eyes of 42 consecutive patients with cytologically proven limbal deficiency (LD) were included in this prospective study. Based on the severity of LD, group A (mild) with 18 eyes received AMT alone, group B (moderate) with 13 eyes received AMT and ALT, and group C (severe) with 16 eyes received AMT, ALT and penetrating keratoplasty. All except for group A received continuous systemic cyclosporin A.


RESULTS
Except for the two eyes with atopy, all amniotic membrane-covered surfaces showed rapid epithelialization in 2-4 weeks, reduced inflammation, vascularization and scarring, and became smooth. For the mean follow-up period of 23 months, 38 eyes (82.6%) showed visual improvement, consisting of > or = 6 lines (15 eyes), 4-5 lines (10 eyes), 1-3 lines (13 eyes). Visual improvement was noted in 16/18 eyes (88.9%) in group A, in 10/13 eyes (77%) in group B, and in 12/16 eyes (75%) in group C. In group C corneal graft rejection occurred in 12 of 16 eyes (75%). In group B and C, early reversible limbal allograft rejection was noted in 3 of 29 eyes (10.3%) and a recurrent limbal deficiency was observed in 8 of 29 eyes (27.6%).


CONCLUSIONS
For partial LD with superficial involvement, AMT alone is sufficient and hence superior to ALT because of no need for using cyclosporin A. For total LD, additional ALT is needed and AMT helps reconstruct the perilimbal stroma with reduced inflammation and vascularization, which collectively may enhance ALT success.
Meller
D
D
Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA.
Tseng
S C
SC
D000650:Amnion / Q000637:transplantation*; D017690:Cell Transplantation; D003261:Contact Lenses / Q000009:adverse effects; D003316:Corneal Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016572:Cyclosporine / Q000627:therapeutic use; D019573:Epithelium, Corneal / Q000473:pathology; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007637:Keratoconjunctivitis / Q000601:surgery; D016850:Limbus Corneae / Q000166:cytology*; D011182:Postoperative Care; D011446:Prospective Studies; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine