Amniotic Membrane Transplantation With or Without Limbal Allografts for Corneal Surface Reconstruction in Patients With Limbal Stem Cell Deficiency

TLDR

The study investigates whether amniotic membrane transplantation improves the success of allograft limbal transplantation in patients with limbal stem cell deficiency. Thirty‑one eyes of 26 patients with cytologically proven limbal deficiency were treated according to severity: mild cases received AMT alone, moderate cases received AMT plus ALT, and severe cases received AMT, ALT, and penetrating keratoplasty, with cyclosporine given to all but the mild group. During a mean 15.4‑month follow‑up, 83% of eyes showed visual improvement (6+ lines in 13 eyes, 4–5 lines in 6 eyes, 1–3 lines in 6 eyes), rapid epithelialization and reduced inflammation were observed in all but two atopic eyes, but success decreased with severity and graft rejection was common in the severe group.

Abstract

<h3>Objective</h3> To examine whether amniotic membrane transplantation (AMT), in preparing the perilimbal stroma, enhances the success of allograft limbal transplantation (ALT). <h3>Methods</h3> Thirty-one eyes of 26 consecutive patients had cytologically proven limbal deficiency resulting from chemical burns (14 eyes); Stevens-Johnson syndrome, toxic epidermal necrolysis, or pseudopemphigoid (5 eyes); contact lens–induced keratopathy (3 eyes); aniridia (3 eyes); multiple surgical procedures (2 eyes); atopy (2 eyes); or an unknown cause (2 eyes). Based on the severity of limbal deficiency, group A (mild), comprising 10 eyes, received AMT alone; group B (moderate), comprising 7 eyes, received AMT and ALT; and group C (severe), comprising 14 eyes, received AMT, ALT, and penetrating keratoplasty. All patients except those in group A received continuous oral cyclosporine. <h3>Results</h3> Except for the 2 eyes with atopy, all amniotic membrane–covered surfaces showed rapid epithelialization (in 2 to 4 weeks) and reduced inflammation, vascularization, and scarring, and the surfaces became smooth and wettable. For the mean follow-up period of 15.4 months, 25 (83%) of 30 eyes showed visual improvement, consisting of 6 or more lines (13 eyes), 4 to 5 lines (6 eyes), or 1 to 3 lines (6 eyes). Visual improvement decreased with the severity of limbal deficiency from 8 (100%) of 8 eyes in group A to 5 (71%) of 7 eyes in group B and 11 (79%) of 14 eyes in group C. In group C, corneal graft rejection occurred in 9 (64%) of 14 eyes, and reversible early limbal allograft rejection was noted in 3 (14%) of 21 eyes of groups B and C. <h3>Conclusions</h3> For partial limbal deficiency with superficial involvement, AMT alone is sufficient and hence superior to ALT because there is no need to administer cyclosporine. For total limbal deficiency, additional ALT is needed, and AMT helps reconstruct the perilimbal stroma, with reduced inflammation and vascularization, which collectively may enhance the success of ALT.