AMNIOTIC MEMBRANE TRANSPLANTATION WITH OR WITHOUT LIMBAL ALLOGRAFTS FOR CORNEAL SURFACE RECONSTRUCTION IN PATIENTS WITH LIMBAL STEM-CELL DEFICIENCY

Objective: To examine whether amniotic membrane transplantation (AMT), in preparing the perilimbal stroma, enhances the success of allograft limbal transplantation (ALT). Methods: Thirty-one eyes of 26 consecut ive patients had cytologically proven limbal deficiency resulting from chemical burns (14 eyes); Stevens-Johnson syndrome, toxic epidermal n ecrolysis, or pseudopemphigoid (5 eyes); contact lens-induced keratopa thy (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; a nd group C (severe), comprising 14 eyes, received AMT, ALT, and penetr ating keratoplasty. All patients except those in group A received cont inuous oral cyclosporine. Results: Except for the 2 eyes with atopy, a ll amniotic membrane-covered surfaces showed rapid epithelialization ( in 2 to 4 weeks) and reduced inflammation, vascularization, and scarri ng, and the surfaces became smooth and wettable. For the mean follow-u p 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 o f 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, corne al graft rejection occurred in 9 (64%) of 14 eyes, and reversible earl y limbal allograft rejection was noted in 3 (14%) of 21 eyes of groups B and C. Conclusions: 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 deficie ncy, additional ALT is needed, and AMT helps reconstruct the perilimba l stroma, with reduced inflammation and vascularization, which collect ively may enhance the success of ALT.