Purpose: To study the association between surgical approach and postoperative results in chemical and thermal burns of the cornea. Design: Retrospective, interventional, noncomparable case series. Participants: Thirty-two eyes of 32 patients with chemical (n = 27) or thermal (n = 5) burns of the cornea that were associated with total limbal dysfunction. Eight eyes had a history of previous keratoplasty. Intervention: Patients were treated by amniotic membrane transplantation combined with either conjunctivolimbal autograft transplantation (autograft group, n = 11) or keratolimbal allograft transplantation (allograft group, n = 21). Fifteen eyes had simultaneous penetrating keratoplasty (simultaneous group), and 6 had keratoplasty several months after ocular surface reconstruction (2-step group). Main Outcome Measures: Reconstruction of the corneal surface by corneal epithelium, clarity of the cornea, and incidence of postoperative complications. The outcome was compared between the autograft and allograft groups and also between the simultaneous and 2-step groups. Results: At final examination, 17 eyes (53.1%) showed stable corneal epithelialization. Preoperative conditions were similar in the autograft and allograft groups and also in the simultaneous and 2-step groups. The autograft group showed significantly better results than the allograft group in both corneal epithelialization (Kaplan-Meier analysis, P = 0.003) and clear cornea (P = 0.010). Although the incidences of corneal epithelialization and clear corneas did not significantly differ between the simultaneous and 2-step groups, the former had a higher rate of endothelial rejection in the central graft (P = 0.019). Conclusions: In chemical or thermal burns of the cornea with monocular involvement, autografting should be considered as a first choice of surgery. Even in eyes with opaque corneal stroma, it may be safer to perform ocular surface reconstruction first, followed by keratoplasty as a secondary procedure.
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