title: [Severe limbal deficiency treated by combined limbal allograft and amniotic membrane transplantation].
abstract: OBJECTIVE
  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.
authors.affiliation: Hospital Cruz Roja y Hospital Ramón y Cajal, Madrid, Spain. docsantilopez@hotmail.com
authors.forename: J S
authors.initials: JS
authors.lastname: López-García
authors.forename: L
authors.initials: L
authors.lastname: Rivas
authors.forename: I
authors.initials: I
authors.lastname: García-Lozano
mesh_terms: D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation*; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D019573:Epithelium, Corneal / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity