Surgical procedures for grade III patients were as follows: CLAU (6 eyes); AMT/CLAU (3 eyes); AMT/CLAL (1 eye); and CLAL followed by PKP (1 eye).
In 2 of the grade IV patients, limbal stem cell deficiency recurred after CLAU in one and after KLAL and PKP in the other.
Besides the surgical procedures to the ocular surface, entropion surgery was performed prior to CLAU or CLAL in 2 eyes with trichiasis and entropion; buccal mucosal membrane graft with eyelid and fornix reconstruction was performed in 2 eyes with symblepharon.
The advantages of AMT in ocular surface reconstruction include reducing perilimbal inflammation, creating a healthy corneal epithelium, reducing corneal neovascularization and enhancing the success of subsequent limbal stem cell transplant and/or PKP (2,16) We used this technique primarily in grade III-IV patients in combination with CLAU or KLAL transplantation to provide a healthy ocular surface and/or prior to PKP to increase the likelihood of success.
While satisfactory results are achievable in unilateral limbal stem cell deficiency with CLAU transplantation, the same is not true for patients with bilateral disease.
26) Only one third of patients who underwent CLAU transplantation had corneal epithelialization after the first procedure; most eyes required repeated surgery.