Abstract
AIM—To examine the efficacy, safety, and long term outcomes of amniotic membrane transplantation for corneal surface reconstruction in cases of partial limbal stem cell deficiency. METHODS—17 eyes of 15 patients with partial limbal stem cell deficiency underwent superficial keratectomy of the conjunctivalised corneal surface followed by amniotic membrane transplantation. Cases were followed up for at least a year. RESULTS—All eyes exhibited a stable, intact corneal epithelial surface after a mean follow up period of 25.8 months with no eyes developing recurrent erosion or persistent epithelial defect. The mean time to re-epithelialisation was 22.8 days. Overall improvement in visual acuity was observed in 92.9% of 14 eyes with visual potential. Of those, five eyes gained six or more lines, two eyes gained between four and five lines, six eyes gained between one and three lines, and one eye lost three lines of Snellen acuity. Pain and photophobia were abolished in 86% of cases and substantially reduced in 14%, with all eyes exhibiting decreased vascularisation and inflammation at final follow up. CONCLUSIONS—Amniotic membrane transplantation appears to be a safe and effective method of restoring a stable corneal epithelium for cases of partial limbal stem cell deficiency and can be considered as an alternative to limbal autograft or allograft.
Full Text
The Full Text of this article is available as a PDF (315.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Azuara-Blanco A., Pillai C. T., Dua H. S. Amniotic membrane transplantation for ocular surface reconstruction. Br J Ophthalmol. 1999 Apr;83(4):399–402. doi: 10.1136/bjo.83.4.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Basti S., Mathur U. Unusual intermediate-term outcome in three cases of limbal autograft transplantation. Ophthalmology. 1999 May;106(5):958–963. doi: 10.1016/S0161-6420(99)00516-3. [DOI] [PubMed] [Google Scholar]
- Boudreau N., Sympson C. J., Werb Z., Bissell M. J. Suppression of ICE and apoptosis in mammary epithelial cells by extracellular matrix. Science. 1995 Feb 10;267(5199):891–893. doi: 10.1126/science.7531366. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cardoen L., Foets B. Limbal transplantation after chemical injuries of the eye. Bull Soc Belge Ophtalmol. 1999;272:105–110. [PubMed] [Google Scholar]
- Chen J. J., Tseng S. C. Abnormal corneal epithelial wound healing in partial-thickness removal of limbal epithelium. Invest Ophthalmol Vis Sci. 1991 Jul;32(8):2219–2233. [PubMed] [Google Scholar]
- Chen J. J., Tseng S. C. Corneal epithelial wound healing in partial limbal deficiency. Invest Ophthalmol Vis Sci. 1990 Jul;31(7):1301–1314. [PubMed] [Google Scholar]
- Cho B. J., Djalilian A. R., Obritsch W. F., Matteson D. M., Chan C. C., Holland E. J. Conjunctival epithelial cells cultured on human amniotic membrane fail to transdifferentiate into corneal epithelial-type cells. Cornea. 1999 Mar;18(2):216–224. doi: 10.1097/00003226-199903000-00013. [DOI] [PubMed] [Google Scholar]
- Choi Y. S., Kim J. Y., Wee W. R., Lee J. H. Effect of the application of human amniotic membrane on rabbit corneal wound healing after excimer laser photorefractive keratectomy. Cornea. 1998 Jul;17(4):389–395. doi: 10.1097/00003226-199807000-00009. [DOI] [PubMed] [Google Scholar]
- Copeland R. A., Jr, Char D. H. Limbal autograft reconstruction after conjunctival squamous cell carcinoma. Am J Ophthalmol. 1990 Oct 15;110(4):412–415. doi: 10.1016/s0002-9394(14)77023-0. [DOI] [PubMed] [Google Scholar]
- Cotsarelis G., Cheng S. Z., Dong G., Sun T. T., Lavker R. M. Existence of slow-cycling limbal epithelial basal cells that can be preferentially stimulated to proliferate: implications on epithelial stem cells. Cell. 1989 Apr 21;57(2):201–209. doi: 10.1016/0092-8674(89)90958-6. [DOI] [PubMed] [Google Scholar]
- Dua H. S., Azuara-Blanco A. Allo-limbal transplantation in patients with limbal stem cell deficiency. Br J Ophthalmol. 1999 Apr;83(4):414–419. doi: 10.1136/bjo.83.4.414. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dua H. S., Azuara-Blanco A. Autologous limbal transplantation in patients with unilateral corneal stem cell deficiency. Br J Ophthalmol. 2000 Mar;84(3):273–278. doi: 10.1136/bjo.84.3.273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dua H. S., Gomes J. A., Singh A. Corneal epithelial wound healing. Br J Ophthalmol. 1994 May;78(5):401–408. doi: 10.1136/bjo.78.5.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Frucht-Pery J., Siganos C. S., Solomon A., Scheman L., Brautbar C., Zauberman H. Limbal cell autograft transplantation for severe ocular surface disorders. Graefes Arch Clin Exp Ophthalmol. 1998 Aug;236(8):582–587. doi: 10.1007/s004170050125. [DOI] [PubMed] [Google Scholar]
- Fukuda K., Chikama T., Nakamura M., Nishida T. Differential distribution of subchains of the basement membrane components type IV collagen and laminin among the amniotic membrane, cornea, and conjunctiva. Cornea. 1999 Jan;18(1):73–79. [PubMed] [Google Scholar]
- Gabler B., Lohmann C. P. Hypopyon after repeated transplantation of human amniotic membrane onto the corneal surface. Ophthalmology. 2000 Jul;107(7):1344–1346. doi: 10.1016/s0161-6420(00)00167-6. [DOI] [PubMed] [Google Scholar]
- Gatinel D., Nghiem M. H., Chaine G. Autogreffe de limbe précoce après brûlure alcaline de la surface oculaire. J Fr Ophtalmol. 1999 Feb;22(1):76–78. [PubMed] [Google Scholar]
- Gérard M., Merle H., Chiambaretta F., Louis V., Richer R., Rigal D. Technique chirurgicale de l'autotransplantation limbique dans les brûlures oculaires graves et récentes. J Fr Ophtalmol. 1999 May;22(4):502–506. [PubMed] [Google Scholar]
- Heiligenhaus A., Shore J. W., Rubin P. A., Foster C. S. Long-term results of mucous membrane grafting in ocular cicatricial pemphigoid. Implications for patient selection and surgical considerations. Ophthalmology. 1993 Sep;100(9):1283–1288. doi: 10.1016/s0161-6420(93)31487-9. [DOI] [PubMed] [Google Scholar]
- Holland E. J. Epithelial transplantation for the management of severe ocular surface disease. Trans Am Ophthalmol Soc. 1996;94:677–743. [PMC free article] [PubMed] [Google Scholar]
- Holland E. J., Schwartz G. S. The evolution of epithelial transplantation for severe ocular surface disease and a proposed classification system. Cornea. 1996 Nov;15(6):549–556. [PubMed] [Google Scholar]
- Jenkins C., Tuft S., Liu C., Buckley R. Limbal transplantation in the management of chronic contact-lens-associated epitheliopathy. Eye (Lond) 1993;7(Pt 5):629–633. doi: 10.1038/eye.1993.145. [DOI] [PubMed] [Google Scholar]
- Kenyon K. R. Limbal autograft transplantation for chemical and thermal burns. Dev Ophthalmol. 1989;18:53–58. doi: 10.1159/000417087. [DOI] [PubMed] [Google Scholar]
- Kenyon K. R., Tseng S. C. Limbal autograft transplantation for ocular surface disorders. Ophthalmology. 1989 May;96(5):709–723. doi: 10.1016/s0161-6420(89)32833-8. [DOI] [PubMed] [Google Scholar]
- Kim J. C., Tseng S. C. The effects on inhibition of corneal neovascularization after human amniotic membrane transplantation in severely damaged rabbit corneas. Korean J Ophthalmol. 1995 Jun;9(1):32–46. doi: 10.3341/kjo.1995.9.1.32. [DOI] [PubMed] [Google Scholar]
- Koizumi N., Inatomi T., Quantock A. J., Fullwood N. J., Dota A., Kinoshita S. Amniotic membrane as a substrate for cultivating limbal corneal epithelial cells for autologous transplantation in rabbits. Cornea. 2000 Jan;19(1):65–71. doi: 10.1097/00003226-200001000-00013. [DOI] [PubMed] [Google Scholar]
- Kruse F. E., Rohrschneider K., Völcker H. E. Multilayer amniotic membrane transplantation for reconstruction of deep corneal ulcers. Ophthalmology. 1999 Aug;106(8):1504–1511. doi: 10.1016/S0161-6420(99)90444-X. [DOI] [PubMed] [Google Scholar]
- Lee S. H., Tseng S. C. Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol. 1997 Mar;123(3):303–312. doi: 10.1016/s0002-9394(14)70125-4. [DOI] [PubMed] [Google Scholar]
- Meller D., Tseng S. C. Conjunctival epithelial cell differentiation on amniotic membrane. Invest Ophthalmol Vis Sci. 1999 Apr;40(5):878–886. [PubMed] [Google Scholar]
- Moldovan S. M., Borderie V., Baudrimont M., Laroche L. Traitement du syndrome d'insuffisance en cellules souches limbiques unilatéral par autogreffe de limbe. J Fr Ophtalmol. 1999 Apr;22(3):302–309. [PubMed] [Google Scholar]
- Morgan S., Murray A. Limbal autotransplantation in the acute and chronic phases of severe chemical injuries. Eye (Lond) 1996;10(Pt 3):349–354. doi: 10.1038/eye.1996.72. [DOI] [PubMed] [Google Scholar]
- Prabhasawat P., Barton K., Burkett G., Tseng S. C. Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology. 1997 Jun;104(6):974–985. doi: 10.1016/s0161-6420(97)30197-3. [DOI] [PubMed] [Google Scholar]
- Prabhasawat P., Tseng S. C. Impression cytology study of epithelial phenotype of ocular surface reconstructed by preserved human amniotic membrane. Arch Ophthalmol. 1997 Nov;115(11):1360–1367. doi: 10.1001/archopht.1997.01100160530001. [DOI] [PubMed] [Google Scholar]
- Puangsricharern V., Tseng S. C. Cytologic evidence of corneal diseases with limbal stem cell deficiency. Ophthalmology. 1995 Oct;102(10):1476–1485. doi: 10.1016/s0161-6420(95)30842-1. [DOI] [PubMed] [Google Scholar]
- Rao S. K., Rajagopal R., Sitalakshmi G., Padmanabhan P. Limbal autografting: comparison of results in the acute and chronic phases of ocular surface burns. Cornea. 1999 Mar;18(2):164–171. doi: 10.1097/00003226-199903000-00004. [DOI] [PubMed] [Google Scholar]
- Ronk J. F., Ruiz-Esmenjaud S., Osorio M., Bacigalupi M., Goosey J. D. Limbal conjunctival autograft in a subacute alkaline corneal burn. Cornea. 1994 Sep;13(5):465–468. doi: 10.1097/00003226-199409000-00017. [DOI] [PubMed] [Google Scholar]
- Rubsamen P. E., Irvin W. D., McCuen B. W., 2nd, Smiddy W. E., Bowman C. B. Primary intraocular lens implantation in the setting of penetrating ocular trauma. Ophthalmology. 1995 Jan;102(1):101–107. doi: 10.1016/s0161-6420(95)31073-1. [DOI] [PubMed] [Google Scholar]
- Schermer A., Galvin S., Sun T. T. Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells. J Cell Biol. 1986 Jul;103(1):49–62. doi: 10.1083/jcb.103.1.49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwab I. R. Cultured corneal epithelia for ocular surface disease. Trans Am Ophthalmol Soc. 1999;97:891–986. [PMC free article] [PubMed] [Google Scholar]
- Shimazaki J., Shinozaki N., Tsubota K. Transplantation of amniotic membrane and limbal autograft for patients with recurrent pterygium associated with symblepharon. Br J Ophthalmol. 1998 Mar;82(3):235–240. doi: 10.1136/bjo.82.3.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shimazaki J., Yang H. Y., Tsubota K. Amniotic membrane transplantation for ocular surface reconstruction in patients with chemical and thermal burns. Ophthalmology. 1997 Dec;104(12):2068–2076. doi: 10.1016/s0161-6420(97)30057-8. [DOI] [PubMed] [Google Scholar]
- Tan D. T., Ficker L. A., Buckley R. J. Limbal transplantation. Ophthalmology. 1996 Jan;103(1):29–36. doi: 10.1016/s0161-6420(96)30737-9. [DOI] [PubMed] [Google Scholar]
- Theng J. T., Tan D. T. Combined penetrating keratoplasty and limbal allograft transplantation for severe corneal burns. Ophthalmic Surg Lasers. 1997 Sep;28(9):765–768. [PubMed] [Google Scholar]
- Tsai R. J., Sun T. T., Tseng S. C. Comparison of limbal and conjunctival autograft transplantation in corneal surface reconstruction in rabbits. Ophthalmology. 1990 Apr;97(4):446–455. doi: 10.1016/s0161-6420(90)32575-7. [DOI] [PubMed] [Google Scholar]
- Tsai R. J., Tseng S. C. Human allograft limbal transplantation for corneal surface reconstruction. Cornea. 1994 Sep;13(5):389–400. doi: 10.1097/00003226-199409000-00003. [DOI] [PubMed] [Google Scholar]
- Tseng S. C., Li D. Q., Ma X. Suppression of transforming growth factor-beta isoforms, TGF-beta receptor type II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix. J Cell Physiol. 1999 Jun;179(3):325–335. doi: 10.1002/(SICI)1097-4652(199906)179:3<325::AID-JCP10>3.0.CO;2-X. [DOI] [PubMed] [Google Scholar]
- Tseng S. C., Prabhasawat P., Barton K., Gray T., Meller D. Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency. Arch Ophthalmol. 1998 Apr;116(4):431–441. doi: 10.1001/archopht.116.4.431. [DOI] [PubMed] [Google Scholar]
- Tseng S. C., Prabhasawat P., Lee S. H. Amniotic membrane transplantation for conjunctival surface reconstruction. Am J Ophthalmol. 1997 Dec;124(6):765–774. doi: 10.1016/s0002-9394(14)71693-9. [DOI] [PubMed] [Google Scholar]
- Tseng S. C. Regulation and clinical implications of corneal epithelial stem cells. Mol Biol Rep. 1996;23(1):47–58. doi: 10.1007/BF00357072. [DOI] [PubMed] [Google Scholar]
- Tseng S. C., Tsubota K. Important concepts for treating ocular surface and tear disorders. Am J Ophthalmol. 1997 Dec;124(6):825–835. doi: 10.1016/s0002-9394(14)71700-3. [DOI] [PubMed] [Google Scholar]
- Tsubota K., Satake Y., Kaido M., Shinozaki N., Shimmura S., Bissen-Miyajima H., Shimazaki J. Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation. N Engl J Med. 1999 Jun 3;340(22):1697–1703. doi: 10.1056/NEJM199906033402201. [DOI] [PubMed] [Google Scholar]
- Tsubota K., Satake Y., Ohyama M., Toda I., Takano Y., Ono M., Shinozaki N., Shimazaki J. Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome. Am J Ophthalmol. 1996 Jul;122(1):38–52. doi: 10.1016/s0002-9394(14)71962-2. [DOI] [PubMed] [Google Scholar]
- Tsubota K., Shimazaki J. Surgical treatment of children blinded by Stevens-Johnson syndrome. Am J Ophthalmol. 1999 Nov;128(5):573–581. doi: 10.1016/s0002-9394(99)00224-x. [DOI] [PubMed] [Google Scholar]
- Tsubota K., Toda I., Saito H., Shinozaki N., Shimazaki J. Reconstruction of the corneal epithelium by limbal allograft transplantation for severe ocular surface disorders. Ophthalmology. 1995 Oct;102(10):1486–1496. doi: 10.1016/s0161-6420(95)30841-x. [DOI] [PubMed] [Google Scholar]