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F. Majo, L. Zografos, P. Othenin–Girard; A new surgical procedure to prevent limbus insufficiency after proton beam therapy for iris melanoma. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2953.
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Purpose:Ocular surface complication is the most important challenge after proton beam therapy for iris melanoma. It usually appears two or three weeks after the irradiation, it looks like limbus insufficiency. Clinical signs are observed from a few months to a couple of years. We describe a new surgical procedure to prevent those ocular surface complications. Methods:Five patients were enrolled in this study. Preoperatively, ocular surface was examined: redness, quality of the tear film (BUT, Shirmer) and transparency of the cornea. We removed half of the limbus before the irradiation and conserved it in an organoculture medium at +4°C for five days. Then, proton beam therapy was performed during four days four time a day. At the end of the treatment, the patient was anaesthetized and the limbus put back where it belonged. Results:Ocular surface of our five patients was dramatically healthy with this technique compared with the patients treated for the same disease without radioprotection of the limbus area. Current complications – like corneal melting, chronic epithelial defect, chronic inflammation and in few cases, limbus insufficiency – have not been noticed. Conclusions:This new procedure seems to be useful to prevent ocular surface complication or limbus insufficiency after eye irradiation. Those data precise the keyplace of the limbus in the ocular surface, not only as a stem cell storage tank for the cornea but also as a regulator of the inflammation in ocular surface.
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