Original article
Modified Simple Limbal Epithelial Transplantation Using Cryopreserved Amniotic Membrane for Unilateral Limbal Stem Cell Deficiency

https://doi.org/10.1016/j.ajo.2014.06.002Get rights and content

Purpose

To report the results of simple limbal epithelial transplantation using a double-layered cryopreserved amniotic membrane graft for the management of unilateral limbal stem cell deficiency.

Design

Retrospective case series.

Methods

Four consecutive patients with unilateral partial (2 eyes) and total (2 eyes) limbal stem cell deficiency secondary to ocular surface burns (2 eyes), trauma (1 eye) and conjunctival melanoma treatment (1 eye) underwent modified simple limbal epithelial transplantation at Bascom Palmer Eye Institute. Preoperative and postoperative visual acuity and quality of corneal epithelium were evaluated.

Results

The patients were followed up for a mean ± standard deviation of 7.5 ± 1.3 months. The donor eye returned to a healthy state in all patients. All patients had significant improvement in visual acuity and resolution of ocular pain in the affected eye. Regular corneal epithelium and a quiet ocular surface were obtained in all patients by a median of 4 weeks.

Conclusions

Compared with the currently used surgical techniques for management of limbal stem cell deficiency, simple limbal epithelial transplantation seems to be a safe, reproducible, and effective alternative. The use of a double layer allows more protection for the explant without impacting outcomes. Also, the use of cryopreserved amniotic membrane allows surgeons to perform this procedure in the Unites States. More cases with longer follow-up will be needed to assess the outcomes further.

Section snippets

Methods

This study was a retrospective case series of 4 consecutive patients. Through it, we present our experience at Bascom Palmer Eye Institute and the Miami Veterans Affairs Hospital using the simple limbal epithelial transplantation technique to manage unilateral partial or complete limbal stem cell deficiency.

The study was conducted in accordance with the tenets of the Declaration of Helsinki, federal and Florida laws, and the Health Insurance Portability and Accountability Act. This study was

Results

Demographics and clinical details of the 4 patients are provided in the Table. Two females and 2 males were included with a mean age ± standard deviation of 59.8 ± 10.9 years. Duration of limbal stem cell deficiency varied between 3 and 45 years, with a median of 15.5 years. Two eyes of 2 patients had partial unilateral limbal stem cell deficiency secondary to chemical injury (1 eye) and trauma (1 eye), and 2 eyes had total unilateral limbal stem cell deficiency secondary to chemical injury (1

Discussion

In this study, the simple limbal epithelial transplantation technique was used to restore corneal epithelium in 4 patients with unilateral partial or total stem cell deficiency using cryopreserved amniotic membrane graft. Moreover, a double amniotic membrane graft step was used as modification to protect the transplanted limbal stem cells. This procedure was easy to perform and involves only simple surgical techniques that can be replicated by most ophthalmic surgeons. We strongly believe that

Guillermo Amescua, MD received his medical degree from the Ignacio A. Santos-Tech of Monterrey School of Medicine. He completed an ophthalmology residency at the University of Pittsburgh School of Medicine. He then completed two fellowship trainings in Cornea, and Uveitis at the Bascom Palmer Eye Institute where he currently is an assistant professor.

His areas of clinical practice are ocular surface and cataracts. His research interests are in infectious keratitis, limbal stem cell deficiency

References (33)

  • C.M. Rohaina et al.

    Reconstruction of limbal stem cell deficient corneal surface with induced human bone marrow mesenchymal stem cells on amniotic membrane

    Transl Res

    (2014)
  • K. Nishida

    Tissue engineering of the cornea

    Cornea

    (2003)
  • Limbal stem cell transplantation: an evidence-based analysis

    Ont Health Technol Assess Ser

    (2008)
  • J.H. Krachmer et al.

    Cornea

    (2011)
  • J.J. Chen et al.

    Abnormal corneal epithelial wound healing in partial-thickness removal of limbal epithelium

    Invest Ophthalmol Vis Sci

    (1991)
  • V.S. Sangwan et al.

    Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency

    Br J Ophthalmol

    (2012)
  • Cited by (0)

    Guillermo Amescua, MD received his medical degree from the Ignacio A. Santos-Tech of Monterrey School of Medicine. He completed an ophthalmology residency at the University of Pittsburgh School of Medicine. He then completed two fellowship trainings in Cornea, and Uveitis at the Bascom Palmer Eye Institute where he currently is an assistant professor.

    His areas of clinical practice are ocular surface and cataracts. His research interests are in infectious keratitis, limbal stem cell deficiency and keratoprosthesis.

    Victor L. Perez, MD received his medical doctorate from the University of Puerto Rico. He performed his ophthalmology residency training, and cornea and uveitis fellowships at Harvard Medical School Department of Ophthalmolgy. He completed two research fellowships in Ocular Immunology at Schepens Eye Research Institute and Brigham & Women's Hospital. He is the director of the Ocular Surface Center and is the Walter G. Ross Distinguished Chair in Ophthalmic Research Programs at the Bascom Palmer Eye Institute.

    View full text