Article

Amniotic membrane transplantation with conjunctival limbal autograft for total limbal stem cell deficiency.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA.
Ophthalmology (impact factor: 5.45). 09/2003; 110(8):1585-92. DOI:10.1016/S0161-6420(03)00503-7 pp.1585-92
Source: PubMed

ABSTRACT To evaluate the outcomes of corneal surface reconstruction with conjunctival limbal autograft when combined with amniotic membrane transplantation on both the donor and recipient eyes.
Retrospective, noncomparative, interventional small case series.
Five eyes of five patients with total limbal stem cell deficiency (LSCD) resulting from pseudopemphigoid (n = 1), chemical burns (n = 3), and extensive removal of conjunctival intraepithelial neoplasia (n = 1) were operated on by one surgeon (SCGT).
After the removal of fibrovascular pannus from the corneal surface, two conjunctival limbal free grafts were harvested from the fellow eyes in all five patients with unilateral LSCD. Amniotic membrane, with the basement membrane side up, was grafted onto the defect created at the donor site and onto the recipient corneal and limbal sclera before placement of conjunctival limbal grafts.
Symptomatic relief, improvement in visual acuity, fornix deepening, and rapid healing and restoration of normal cornea and limbus in the recipient and donor eyes were assessed.
During the mean follow-up of 22 months (range, 11-48 months), all eyes experienced symptomatic relief. All recipient eyes had a mean improvement in visual acuity of nine lines (range, 7-12). The three eyes with stromal vascularization showed regression, and all recipient eyes had marked improvement in corneal clarity. Three eyes receiving simultaneous symblepharon lysis and fornix reconstruction successfully regained deep, stable fornices. The donor eyes showed rapid healing and restoration of the normal limbal landmark, even in one eye where nearly the entire limbus was removed.
Limbal conjunctival transplantation is an effective procedure for restoring the corneal surface integrity in eyes with total LSCD. The additional use of amniotic membrane may contribute to a higher rate of success in the recipient eye and a lower rate of complications in the donor eye, as well as allow the simultaneous correction of concomitant cicatricial abnormalities.

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    Kyoko Ono, Seiichi Yokoo, Tatsuya Mimura, Tomohiko Usui, Kazunori Miyata, Makoto Araie, Satoru Yamagami, Shiro Amano
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Keywords

chemical burns
 
concomitant cicatricial abnormalities
 
corneal clarity
 
corneal surface
 
corneal surface integrity
 
corneal surface reconstruction
 
donor eyes
 
entire limbus
 
extensive removal
 
fellow eyes
 
five patients
 
higher rate
 
lower rate
 
normal cornea
 
rapid healing
 
recipient eyes
 
simultaneous correction
 
stromal vascularization
 
three eyes
 
total limbal