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Allogenic Limbo-keratoplasty with Conjunctivoplasty, Mitomycin C, and Amniotic Membrane for Bilateral Limbal Stem Cell Deficiency
- Source :
- Ophthalmology. 119:930-937
- Publication Year :
- 2012
- Publisher :
- Elsevier BV, 2012.
-
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). Design Retrospective, consecutive subject cohort study. Participants 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. Main Outcome Measures 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. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
- Subjects :
- Adult
Male
Alkylating Agents
medicine.medical_specialty
Visual acuity
Mitomycin
Visual Acuity
Limbus Corneae
Corneal Diseases
Ophthalmology
Humans
Transplantation, Homologous
Medicine
Amnion
Retrospective Studies
Corneal epithelium
business.industry
Stem Cells
Graft Survival
Mitomycin C
Retrospective cohort study
Middle Aged
Mycophenolic Acid
medicine.disease
eye diseases
Thermal burn
Surgery
Transplantation
medicine.anatomical_structure
Quartile
Aniridia
Cyclosporine
Female
medicine.symptom
business
Conjunctiva
Immunosuppressive Agents
Keratoplasty, Penetrating
Follow-Up Studies
Subjects
Details
- ISSN :
- 01616420
- Volume :
- 119
- Database :
- OpenAIRE
- Journal :
- Ophthalmology
- Accession number :
- edsair.doi.dedup.....6cb55705b40f8966536c52b7ebd2e8ed