Survival analysis of conjunctival limbal grafts and amniotic membrane transplantation in eyes with total limbal stem cell deficiency.
OBJECTIVE
To evaluate the survival of conjunctival limbal grafts and amniotic membrane transplantation (AMT) for total limbal stem cell deficiency (LSCD) and the influence of several parameters as cause of LSCD, dry eye, keratinization, eyelid abnormalities, HLA compatibility, systemic immunosuppression, and keratoplasty (PKP) on surgical outcome.


METHODS
Prospective, noncomparative, interventional case series.


METHODS
Thirty-three eyes of 31 patients with total LSCD that underwent conjunctival limbal grafts and AMT at the Department of Ophthalmology, Federal University of São Paulo were included in this study. Cumulative graft survival as well as the influence of several variables on surgical outcome was analyzed.


RESULTS
Ten eyes (30%) underwent conjunctival limbal autograft and 23 (70%) underwent conjunctival limbal allograft from living HLA-matched donor. Graft survival was seen in 13 eyes (40%) at 1 year and in 11 eyes (33.3%) at 2 years, with a cumulative survival of 33% after a mean follow-up time of 33 months. Increase in postoperative visual acuity was observed in 20 eyes (60.6%) during this period. Marked impact on graft survival was observed for patients with Stevens-Johnson syndrome, dry eye, keratinization, eyelid abnormalities, and allogeneic conjunctival limbal transplantation (independently of HLA compatibility) (P < .05). Preoperative dry eye was the most important prognostic parameter for surgical outcome (P < .001).


CONCLUSIONS
Conjunctival limbal grafts associated with AMT are useful for restoring corneal epithelium phenotype in eyes with total LSCD. However, the cumulative survival declines substantially over a 2-year period. Considering all investigated variables, dry eye was the most important prognostic parameter.
Santos
Myrna S
MS
Cornea and External Disease Service, Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil. myrna_serapiao@uol.com.br
Gomes
José A P
JA
Hofling-Lima
Ana Luisa
AL
Rizzo
Luiz V
LV
Romano
André C
AC
Belfort
Rubens
R
D000328:Adult; D000650:Amnion / Q000637:transplantation*; D003228:Conjunctiva / Q000166:cytology*; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D004847:Epithelial Cells / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006650:Histocompatibility Testing; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D011446:Prospective Studies; D013234:Stem Cells / Q000473:pathology*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing