[Severe limbal deficiency treated by combined limbal allograft and amniotic membrane transplantation].

Purpose: 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.