Amniotic membrane transplantation with conjunctival limbal autograft for total limbal stem cell deficiency.
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.
Article: Autologous transplantation of conjunctival epithelial cells cultured on amniotic membrane in a rabbit model.[show abstract] [hide abstract]
ABSTRACT: To evaluate the feasibility of autologous transplantation in a rabbit model of conjunctival epithelial cells cultured on amniotic membrane for ocular surface reconstruction. Limbal stem cell deficiency was induced in the right eyes of 30 rabbits. This was done by performing a lamellar keratectomy of the entire cornea and a complete removal of the limbus and conjunctiva, extending 5 mm outside the limbus. Autologous conjunctival specimens were obtained from the left eyes of ten of those rabbits and cultured for four weeks on denuded amniotic membrane. Cultured epithelium was examined by transmission electron microscopy. Four weeks after lamellar keratectomy, conjunctivalized corneal surfaces were excised and autologous cultured conjunctival epithelial sheets transplanted (Conj-AM group, n=10). The controls were rabbits that underwent corneal surface removal but not transplantation (No Transplantation group, n=10) and those that underwent corneal surface removal but received only amniotic membrane (AM Alone group, n=10). A neovascularization and corneal opacity scoring system was used to evaluate each eye in the two months after surgery. Cultured conjunctival epithelium formed three to four layers on denuded amniotic membrane. Averaged scores of corneal neovascularization and corneal opacity two months after transplantation were significantly low in the Conj-AM group as compared with those in the AM and no transplantation groups. Transplantation of autologous conjunctival epithelial cells cultured on amniotic membrane should prove an effective strategy for treating total limbal stem cell deficiency.Molecular vision 02/2007; 13:1138-43. · 2.20 Impact Factor
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ABSTRACT: In recent years, it has become generally accepted that the corneal epithelial stem cells are localized in the basal cell layer of the limbal epithelium. However, a number of questions remain regarding the number, markers, generation, and maintenance of the corneal epithelial stem cells. One of the key questions concerns what makes up the microenvironment or niche that is responsible for allowing the stem cells to remain and function throughout the life of the tissue. This review will consider the unique aspects of the limbus and compare these to what is known about other stem cell niches.The ocular surface 02/2005; 3(1):15-26. · 3.93 Impact Factor