Conjunctival resection with and without amniotic membrane graft for the treatment of superior limbic keratoconjunctivitis.
OBJECTIVE
To compare the efficacy of conjunctival resection versus conjunctival resection with amniotic membrane graft (AMG) in patients with superior limbic keratoconjunctivitis not responsive to medical therapies.


METHODS
In a retrospective and comparative study, 16 eyes of 9 patients with long-lasting superior limbic keratoconjunctivitis who were refractory to medical treatment were included. Conjunctival resection was performed in 8 cases, and conjunctival resection with AMG was performed in 8 cases. Subjective symptoms, biomicroscopic signs, and impression cytology were evaluated both pre- and postoperatively.


RESULTS
The mean follow-up period was 46 months, ranging from 1.5 to 6 years. After surgery, all cases undergoing conjunctival resection and 7 of 8 cases undergoing conjunctival resection with AMG remained asymptomatic. One case undergoing conjunctival resection with AMG experienced recurrence, requiring reoperation 2 years later (conjunctival resection without AMG). In this patient, complete disappearance of symptoms and signs was achieved during a 4-year period of follow-up after the second surgery. No intra- or postoperative complications were observed in either group. Preoperative impression cytology disclosed severe squamous metaplasia, and goblet cells were markedly decreased in all patients. Postoperative impression cytology 3 months after surgery did not show any significant improvement in squamous metaplasia in either of the groups.


CONCLUSIONS
Conjunctival resection and conjunctival resection with AMG are effective and safe surgical procedures. Despite the potential benefits of the AMG, this procedure did not provide additional advantages in our study.
Instituto de Microcirugía Ocular de Barcelona, Universidad Autónoma de Barcelona, Spain. gris@imo.es
Oscar
O
Gris
Alicia
A
Plazas
Enrique
E
Lerma
José L
JL
Güell
Laura
L
Pelegrín
Daniel
D
Elíes
D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation*; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000601:surgery*; D004847:Epithelial Cells / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007637:Keratoconjunctivitis / Q000175:diagnosis / Q000601:surgery*; D016850:Limbus Corneae; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing