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Comparative Study of Conjunctival Limbal Transplantation Not Associated With the Use of Amniotic Membrane Transplantation for Treatment of Total Limbal Deficiency Secondary to Chemical Injury

Barreiro, Telma P. MD, PhD; Santos, Myrna S. MD, PhD; Vieira, Ana C. MD; de Nadai Barros, Jeison PhD; Hazarbassanov, Rossen M. MD, PhD; Gomes, José Á. P. MD, PhD

doi: 10.1097/ICO.0000000000000139
Clinical Science

Purpose: The aim of this study was to compare the outcome of conjunctival limbal transplantation with and without the use of amniotic membrane (AM) transplantation for the treatment of limbal deficiency after chemical burns to the eyes.

Methods: This is a retrospective, comparative, interventional case series that included 34 eyes (34 patients) with total limbal deficiency after chemical burns, who were submitted to conjunctival limbal transplantation. Two groups were formed: group 1 (15 eyes) limbal transplantation associated with AM transplantation and group 2 (19 eyes) only limbal transplantation. Success and failure rates, epithelialization time, and visual acuity were compared between the 2 groups.

Results: The mean follow-up period was 19.71 ± 5.6 months in group 1 and 18.26 ± 7.78 months in group 2. The proportion of conjunctival limbal autograft and living-related conjunctival limbal allograft was similar in both groups (P = 0.914). Time until complete epithelialization of the corneal surface was significantly longer in group 1 (P = 0.007). Graft survival was similar in both groups (P = 0.581). Failure rate was also similar in both groups (P = 0.232). The most common cause of failure was transplanted stem cell depletion in group 1 (20% of cases) and rejection in group 2 (10.5%). The visual acuity improved postoperatively in 12 eyes (80%) in group 1 and 16 (84.2%) in group 2 (P = 0.430).

Conclusions: Results with the use of AM associated with conjunctival limbal transplantation in ocular surface reconstruction were similar to those obtained with limbal transplantation alone. Both techniques were found to be satisfactory for ocular surface reconstruction in patients with total limbal deficiency after chemical burns.

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Department of Ophthalmology, Federal University of São Paulo–UNIFESP, São Paulo, Brazil.

Reprints: Telma P. Barreiro, Rua Botucatu, 821, 2 Andar, Vila Clementino, São Paulo 04023-062, Brazil (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received December 12, 2013

Accepted March 23, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.