Amniotic membrane transplantation for partial and total limbal stem cell deficiency secondary to chemical burn

Gomes, José Álvaro Pereira; Santos, Myrna Serapião dos; Cunha, Marcelo; Mascaro, Vera L.úcia Degaspare; Barros, João; Sousa, Luciene Barbosa de

doi:10.1016/s0161-6420(02)01888-2

Cited by 156 publications

(110 citation statements)

References 19 publications

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“…As a result, nine eyes (81.8%) showed improved BCVA. Collectively, this data together with previous studies [6][7][8]10 indicated that AM transplantation alone is sufficient to treat partial LSCD without transplantation of limbal stem cells. Similar to four of 17 eyes reported earlier, 6 one eye with peripheral keratitis showed recurrent stromal vascularization without evidence of conjunctivalization (Figure 1, Right in the fourth row), presumably attributable to the persistent activity of the underlying disease.…”

Section: Discussionsupporting

confidence: 70%

“…CONSISTENT WITH PRIOR STUDIES USING SUTURES, [6][7][8]10 AM transplantation using fibrin glue facilitated rapid epithelialization and restored stable and smooth corneal surfaces in 11 eyes with more than 120 degrees of LSCD (Table). During a mean follow-up of 14.2 ± 7.7 months, the resultant corneal surface was stable and smooth without late fluorescein staining and the underlying stroma showed less vascularization and scarring ( Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that in eyes with partial LSCD, AM promotes expansion of remaining limbal epithelial stem cells. [6][7][8]10 …”

mentioning

confidence: 99%

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Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

Kheirkhah

Casas

Raju

et al. 2008

American Journal of Ophthalmology

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PURPOSE-To evaluate the results of sutureless amniotic membrane (AM) transplantation using fibrin glue for reconstructing corneal surfaces with partial limbal stem cell deficiency (LSCD). DESIGN-Retrospective noncomparative interventional case series.METHODS-Eleven eyes of nine patients that had LSCD with 120 degrees to almost 360 degrees of limbal involvement underwent superficial keratectomy to remove the conjunctivalized pannus followed by AM transplantation using fibrin glue. Additional sutureless AM patch (ProKera; BioTissue, Inc, Miami, Florida, USA) was used in seven patients, and mitomycin C was applied on the cornea in four eyes and during fornix reconstruction in seven eyes. The surgery was repeated in three eyes for residual pannus.RESULTS-During a mean follow-up of 14.2 ± 7.7 months (range, six to 26 months), all eyes maintained a smooth and stable corneal epithelial surface without recurrent erosion or persistent epithelial defect, and showed less stromal cloudiness and vascularization. Best-corrected visual acuity improved in nine eyes (81.8%). Corneal epithelialization proceeded by epithelial growth over AM (n = 4), accompanied by dissolution of AM (n = 4) or a combination of both (n = 3). No complication was noted regarding initial or repeated uses of fibrin glue.CONCLUSION-AM transplantation using fibrin glue appears to be a safe and effective method of restoring a stable corneal epithelium for cases with partial LSCD. This approach avoids the need of transplanting limbal epithelial stem cells. THE MAINTENANCE OF A HEALTHY CORNEAL EPITHElium under both normal and traumatic conditions is provided by a unique subpopulation of stem cells located at the limbus. 1,2 When limbal epithelial stem cells are destroyed and/or their supporting stromal environment becomes dysfunctional, a pathological state known as limbal stem cell deficiency (LSCD) develops (for review; see Reference 3 ). LSCD carries the cytologic evidence of conjunctivalization of the corneal surface by a goblet cell-containing conjunctival epithelium. 4 Pathologically, limbal-deficient corneas exhibit destruction of the basement membrane, superficial neovascularization, chronic inflammation, scarring, and poor epithelial integrity (for reviews; see References 3 and 5 ). Clinically, LSCD is a major cause of corneal blindness unable to be corrected by traditional corneal transplantation alone.For eyes inflicted with partial LSCD, where a part of the limbus is damaged, the corneal surface can be reconstructed by debridement of conjunctivalized epithelium with 6-8 or without 9 transplantation of amniotic membrane (AM). Several studies have shown that in eyes with partial LSCD, AM promotes expansion of remaining limbal epithelial stem cells. [6][7][8]10 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript these studies, sutures were used to secure AM to the cornea following the removal of conjunctivalized pannus from the corneal surface. Recent findings suggest that epithelialization may occur both over and unde...

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

Kheirkhah

Casas

Raju

et al. 2008

American Journal of Ophthalmology

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“…Many diverse action mechanisms have been ascribed to the amniotic membrane for its supplanting with a new basement membrane and a stroma that can suppress inflammation, scarring and angiogenesis (for review see [95]). Importantly, amniotic membrane transplantation alone is sufficient to restore the normal corneal epithelial phenotype in human corneas with partial limbal SC deficiency [96][97][98], indicating that amniotic membrane helps expand residual limbal epithelial SCs in vivo. The above clinical discovery has led others to successfully transplant such an ex vivo expanded human limbal epithelial tissue to treat human corneas with total limbal SC deficiency [34,99,100].…”

Section: Will Restoration Of Niche Support Be Critical For Ex Vivo Exmentioning

confidence: 99%

Niche regulation of corneal epithelial stem cells at the limbus

et al. 2007

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Among all adult somatic stem cells, those of the corneal epithelium are unique in their exclusive location in a defined limbal structure termed Palisades of Vogt. As a result, surgical engraftment of limbal epithelial stem cells with or without ex vivo expansion has long been practiced to restore sights in patients inflicted with limbal stem cell deficiency. Nevertheless, compared to other stem cell examples, relatively little is known about the limbal niche, which is believed to play a pivotal role in regulating self-renewal and fate decision of limbal epithelial stem cells. This review summarizes relevant literature and formulates several key questions to guide future research into better understanding of the pathogenesis of limbal stem cell deficiency and further improvement of the tissue engineering of the corneal epithelium by focusing on the limbal niche.

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“…Alguns autores mostraram resultados satisfatórios com a utilização de membrana amniótica como enxerto após remoção de tumores conjuntivais em 16 olhos (3,16) . Nos casos em que a região do limbo foi parcialmente comprometida pelo tumor ou mesmo pela ressecção cirúrgica com uma margem de segurança ampla, o transplante de membrana amniótica foi útil para tratar a deficiência límbica parcial, pois a membrana serve como substrato para expansão de epitélio corneal (20)(21)(22) . Já nos casos que apresentaram comprometimento total do limbo e foram submetidos a epiteliectomia total, foi importante que o transplante de membrana amniótica fosse associado ao transplante de limbo para que houvesse adequada recuperação da superfície corneal com epitélio normal.…”

Section: Discussionunclassified

Membrana amniótica na reconstrução da superfície ocular após exérese de carcinoma de células escamosas da conjuntiva

Carvalho-rêgo¹,

Gomes²,

Ballalai³

et al. 2008

Arq. Bras. Oftalmol.

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Amniotic membrane transplantation for partial and total limbal stem cell deficiency secondary to chemical burn

Cited by 156 publications

References 19 publications

Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

Niche regulation of corneal epithelial stem cells at the limbus

Membrana amniótica na reconstrução da superfície ocular após exérese de carcinoma de células escamosas da conjuntiva

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