Failure of Ocular Surface Reconstruction with Amniotic Membrane Transplantation and Living-Related Conjunctival Limbal Allograft

Abstract

Abstract: : Purpose: Despite new strategies developed in last years for the treatment of limbal stem cell deficiency, significant failure rates have been reported after ocular surface reconstruction. The purpose of this study is to evaluate the causes of ocular surface reconstruction failure in patients with total limbal stem cell deficiency(LSCD) who underwent living-related conjunctival limbal allograft (lr-CLAL) associated with amniotic membrane transplantation (AM). Methods: Fifteen patients who developed ocular surface reconstruction failure after lr-CLAL associated with AM were included in this study. The causes of failure were characterized and a classification based on time to surgical failure development was established. Results: Nine patients developed LSCD secondary to Stevens-Johnson syndrome (SJS) and 6 secondary to chemical injury. The mean follow-up time was 17.5 months (5-30 mo) and the mean time to surgical failure development was 6.5 months (1-24 mo). Acute failure (<1 month post-op) was observed in 6 patients (40%), early failure (between 1 and 12 months) in 5 patients (33.5%) and late failure (> 12 months post-op) in 4 patients (26.5%). The most frequent cause of failure was chronic inflammation in association with severe dry eye in 7 patients (47%), followed by post-op infection in 4(26.5%), rejection in 2(13.5%), acute inflammation (melting of the graft) in 1(6.5%) and presumed limbal stem cell exhaustion in 1 patient (6.5%). Conclusions: Chronic inflammation in association with severe dry eye was the most frequent cause of ocular surface reconstruction failure in this study. Post-op infection was also an important cause of failure, specially in the acute phase and in patients with SJS.

Keywords: cornea: clinical science • cornea: epithelium • clinical (human) or epidemiologic studies: out