title: Donor source affects the outcome of ocular surface reconstruction in chemical or thermal burns of the cornea.
abstract: OBJECTIVE
  To study the association between surgical approach and postoperative results in chemical and thermal burns of the cornea.
  
  
  METHODS
  Retrospective, interventional, noncomparable case series.
  
  
  METHODS
  Thirty-two eyes of 32 patients with chemical (n = 27) or thermal (n = 5) burns of the cornea that were associated with total limbal dysfunction. Eight eyes had a history of previous keratoplasty.
  
  
  METHODS
  Patients were treated by amniotic membrane transplantation combined with either conjunctivolimbal autograft transplantation (autograft group, n = 11) or keratolimbal allograft transplantation (allograft group, n = 21). Fifteen eyes had simultaneous penetrating keratoplasty (simultaneous group), and 6 had keratoplasty several months after ocular surface reconstruction (2-step group).
  
  
  METHODS
  Reconstruction of the corneal surface by corneal epithelium, clarity of the cornea, and incidence of postoperative complications. The outcome was compared between the autograft and allograft groups and also between the simultaneous and 2-step groups.
  
  
  RESULTS
  At final examination, 17 eyes (53.1%) showed stable corneal epithelialization. Preoperative conditions were similar in the autograft and allograft groups and also in the simultaneous and 2-step groups. The autograft group showed significantly better results than the allograft group in both corneal epithelialization (Kaplan-Meier analysis, P = 0.003) and clear cornea (P = 0.010). Although the incidences of corneal epithelialization and clear corneas did not significantly differ between the simultaneous and 2-step groups, the former had a higher rate of endothelial rejection in the central graft (P = 0.019).
  
  
  CONCLUSIONS
  In chemical or thermal burns of the cornea with monocular involvement, autografting should be considered as a first choice of surgery. Even in eyes with opaque corneal stroma, it may be safer to perform ocular surface reconstruction first, followed by keratoplasty as a secondary procedure.
authors.affiliation: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. jun@eyebank.or.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Shimazaki
authors.forename: Shigeto
authors.initials: S
authors.lastname: Shimmura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation; D001684:Biological Dressings; D002057:Burns, Chemical / Q000209:etiology / Q000601:surgery*; D003228:Conjunctiva / Q000637:transplantation; D003315:Cornea / Q000601:surgery; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D065306:Corneal Injuries; D003657:Decision Making; D005126:Eye Burns / Q000139:chemically induced / Q000601:surgery*; D005260:Female; D006358:Hot Temperature; D006801:Humans; D015948:Keratoplasty, Penetrating; D016850:Limbus Corneae / Q000166:cytology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014019:Tissue Donors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome