title: Allogenic limbo-keratoplasty with conjunctivoplasty, mitomycin C, and amniotic membrane for bilateral limbal stem cell deficiency.
abstract: OBJECTIVE
  To present the technique and report the results of up to 36 months after allogenic central penetrating limbo-keratoplasty in conjunction with conjunctivoplasty, mitomycin C (MMC), and amniotic membrane (AM) transplantation in patients with bilateral limbal stem cell deficiency (LSCD).
  
  
  METHODS
  Retrospective, consecutive subject cohort study.
  
  
  METHODS
  Case records of 20 eyes from 20 patients who presented with bilateral LSCD due to aniridia, chemical/thermal burn, cicatrizing pemphigoid, and chronic ocular surface inflammation and who were treated at the University Eye Hospital, Freiburg.
  
  
  METHODS
  All eyes were treated with central limbo-keratoplasty in conjunction with conjunctivoplasty, MMC, and AM. There were 20 human leukocyte antigen-typed allolimbal transplants from cadaveric donors. All patients received systemic immunosuppression with mycophenolate mofetil or cyclosporine A.
  
  
  METHODS
  Surgical success was measured by the duration for which a healthy corneal epithelium was maintained. Visual success was measured by an improvement in visual acuity (VA) in the eye during follow-up and directly correlated with central clear graft survival.
  
  
  RESULTS
  The follow-up period was up to 34 months (mean, 20 months; median, 22.4 months). Mean VA, measured in decimal fractions, increased from 0.029 (∼20/400; median, 0.005; first quartile 0.005; third quartile 0.005) before surgery to 0.281 (20/70; median, 0.2; first quartile 0.04; third quartile 0.55) after surgery. Healthy corneal epithelium showing survival of limbal stem cells was observed in 14 eyes (70%) during complete follow-up.
  
  
  CONCLUSIONS
  Penetrating limbo-keratoplasty with conjunctivoplasty, MMC, and AM transplantation is a promising new surgical technique for improving vision and conjunctivalization in patients with severe bilateral LSCD necessitating allogenic transplants.
authors.affiliation: University Eye Hospital, Freiburg, Germany. philipp.eberwein@uniklinik-freiburg.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Eberwein
authors.forename: Daniel
authors.initials: D
authors.lastname: Böhringer
authors.forename: Johannes
authors.initials: J
authors.lastname: Schwartzkopff
authors.forename: Florian
authors.initials: F
authors.lastname: Birnbaum
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhard
mesh_terms: D000328:Adult; D000477:Alkylating Agents / Q000008:administration & dosage*; D000650:Amnion / Q000637:transplantation; D003228:Conjunctiva / Q000637:transplantation*; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015948:Keratoplasty, Penetrating / Q000379:methods*; D016850:Limbus Corneae; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D012189:Retrospective Studies; D013234:Stem Cells / Q000473:pathology*; D014184:Transplantation, Homologous; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000477:Alkylating Agents; D007166:Immunosuppressive Agents; D016685:Mitomycin; D016572:Cyclosporine; D009173:Mycophenolic Acid