May 2004
Volume 45, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2004
Survival Analysis of Conjunctival Limbal Grafts from Living Donor and Amniotic Membrane Transplantation for Total Limbal Deficiency
Author Affiliations & Notes
  • M.S. Dos Santos
    Ophthalmology, Vision Institute– Federal University of Sao Paulo–UNIFESP, Sao Paulo, Brazil
  • J.A. P. Gomes
    Ophthalmology, Vision Institute– Federal University of Sao Paulo–UNIFESP, Sao Paulo, Brazil
  • A.L. Hofling–Lima
    Ophthalmology, Vision Institute– Federal University of Sao Paulo–UNIFESP, Sao Paulo, Brazil
  • L.V. Rizzo
    Immunology, ICB – University of Sao Paulo, Sao Paulo, Brazil
  • R. Belfort Jr
    Ophthalmology, Vision Institute– Federal University of Sao Paulo–UNIFESP, Sao Paulo, Brazil
  • Footnotes
    Commercial Relationships  M.S. Dos Santos, None; J.A.P. Gomes, None; A.L. Hofling–Lima, None; L.V. Rizzo, None; R. Belfort Jr, None.
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 3942. doi:
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      M.S. Dos Santos, J.A. P. Gomes, A.L. Hofling–Lima, L.V. Rizzo, R. Belfort Jr; Survival Analysis of Conjunctival Limbal Grafts from Living Donor and Amniotic Membrane Transplantation for Total Limbal Deficiency . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3942.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Abstract: : Purpose:To evaluate the efficacy of conjunctival limbal grafts from living donor and amniotic membrane transplantation (AMT) for ocular surface reconstruction (OSR) in total limbal deficiency (TLD) and the influence of several parameters such as cause of TLD, dry eye syndrome, keratinization, lid abnormalities, HLA compatibility, systemic immunosuppression and keratoplasty (PK) on the surgical outcome.Methods:Thirty three eyes of 31 patients with TLD underwent OSR with conjunctival limbal grafts from living donor and AMT. For bilateral cases, HLA I and II typing and crossmatch of the patient and first–degree relatives were performed. For unilateral cases, conjunctival limbal tissue was obtained from the contralateral eye, whereas in bilaterally committed patients transplants from HLA–matched living related donors were used. Systemic immunosuppressive therapy with cyclosporine A and prednisone was applied to patients with HLA incompatibility and/or after PK. Impression cytology of the corneal epithelium was performed for diagnosis of TLD prior to surgery, as well as for post–operative follow–up. Results: From 33 eyes, 10 (30%) underwent conjunctival limbal autograft and 23(70%)conjunctival limbal allograft from living related donor. PK was associated in 16(48.5%) eyes and systemic immunosuppression was introduced in 17(51.5%)cases. Successful surgical outcome was achieved in 11 (33.3%) cases with a mean follow–up time of 33±12 months. A significant increase in post–operative visual acuity was observed in 20 (60.6%) eyes. Univariant analysis revealed a significant impact on graft survival for the following parameters: cause of TLD, dry eye syndrome, keratinization, lid abnormalities and HLA compatibility (p<0.05). Patients with SJS, dry eye syndrome, keratinization, lid abnormalities and allogenic conjunctival limbal transplants (independently of HLA compatibility), developed graft failure more frequently. Multivariant regression analysis demonstrated that the Schirmer test I prior to surgery was the most important prognostic parameter for surgical outcome (p<0.05).Conclusions: Conjunctival limbal grafts from living donor associated with AMT was efficient for OSR in 33.3% of the eyes with TLD. Considering all investigated parameters with significant impact on the surgical outcome, the dry eye syndrome was identified as the most important for a less favourable result.

Keywords: cornea: epithelium • cornea: clinical science • conjunctiva 
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