Amnion-assisted conjunctival epithelial redirection in limbal stem cell grafting

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Abstract

Aims

To develop a technique using amniotic membrane (AM) to prevent admixture of conjunctival epithelial cells and limbal explant-derived corneal epithelial cells in patients undergoing limbal stem cell transplantation. To compare this technique with the current method of ‘sequential sector conjunctival epitheliectomy’ (SSCE).

Methods

26 patients with total limbal stem cell deficiency who underwent ocular surface reconstruction with limbal stem cells transplantation were retrospectively studied. Patients were categorised into group A (11) in which AM was used to direct the conjunctival epithelial cells away from the corneal surface so that the latter could be covered by the limbal explant-derived epithelial cells—the procedure was termed ‘amnion-assisted conjunctival epithelial redirection’ (ACER)—and group B (15) in which the conjunctival epithelium was prevented from migrating on to the corneal surface by SSCE.

Results

In nine eyes of group A, the conjunctival epithelium was successfully directed on to the AM, preventing admixture with limbal explant-derived corneal epithelial cells. The AM was removed or it came off spontaneously within 1–4 weeks. Patients treated with SSCE (group B) underwent two to four interventions until complete re-epithelialisation. 12 patients had pain or discomfort. 11 patients had conjunctival haemorrhage during SSCE. The cornea was epithelised from the limbal explant-derived epithelium in all patients.

Conclusions

ACER is a viable option in limbal transplantation that reduces multiple patient visits, bleeding and pain that can be associated with SSCE.

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