Amniotic membrane transplantation with and without limbal stem cell transplantation in chemical eye injury
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Introduction: Chemical burns of the eyes are one of the important causes of visual disability. Chemical burns particularly alkali burn may lead to gross limbal stem cell deficiency. Amniotic membrane transplantation with limbal graft is a good method for ocular surface reconstruction. Case: A 39 years male presented to Biratnagar Eye Hospital after 5 months of chemical injury with redness, pain, photophobia and gradual loss of vision. His visual acuity was counting fingers close to face in both eyes. Amniotic membrane transplantation alone was done in right eye while in left eye limbal stem cell allograft was combined with amniotic membrane transplantation. There was not much visual improvement in right eye while left eye improved significantly to 6/60.Conclusion: Limbal stem cell graft with amniotic membrane transplantation can be an effective method of restoring vision and reducing symptoms rather than amniotic membrane transplantation alone in cases with total limbal stem cell deficiency following chemical burn.Keywords:
Limbal stem cell
Photophobia
Chemical burn
Symblepharon
Purpose: To report the results of one 60° conjunctival limbal autograft (CLAU) combined with amniotic membrane (AM) transplantation for an eye with total limbal stem cell deficiency (LSCD). Methods: One eye of a patient with chronic total LSCD and symblepharon caused by chemical burn was subjected to symblepharon lysis, removal of pannus from corneal surface, AM transplantation to cover the conjunctival and corneal surfaces as a permanent graft, one 60° CLAU to the superior limbal area, and insertion of ProKera as a temporary AM patch to cover the CLAU. Results: After surgery, corneal epithelialization over the AM was evident adjacent to the CLAU on day 6, progressed to pass the horizontal midline by day 11, and was completed by day 18. During a follow-up of 1 year, the corneal surface remained stable and smooth, and the stroma considerably regained clarity with regression of midstromal vascularization. The best-corrected visual acuity improved from 20/400 to 20/50. The conjunctival inflammation completely resolved, and the fornices were deep. Conclusions: One 60° CLAU combined with AM transplantation as both a permanent graft and a temporary patch can restore the entire corneal surface in an eye with total LSCD caused by chemical burn.
Symblepharon
Pannus
Limbal stem cell
Chemical burn
Graft rejection
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Chemical burn
Limbal stem cell
Symblepharon
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Symblepharon
Chemical burn
Perforation
Corneal perforation
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Purpose: To evaluate the clinical outcome of Amniotic Membrane Transplantation (AMT) in chemically injured eyes for ocular surface reconstruction. Methods: A prospective study of 30 consecutive chemically injured eyes was performed from December 2022 to May 2023 in National Institute of Ophthalmology & Hospital (NIO&H), Dhaka, Bangladesh. Twenty-seven patients (30 eyes having corrosive chemical injuries) were included in the study according to the inclusion & exclusion criteria. AMT was performed within 21 days of injury by single surgeon with modified surgical procedure. Post operative evaluation was done by Snellen chart, slit lamp biomicroscope and Schirmer-II test. Results: After 3 months of AMT, there was no pain or inflammation. Improvement of vision found in 20 (66.67%) of 30 eyes, 4 (13.33%) eyes of rest 10 eyes showed inaccurate Projection of Rays (PR) vision and rest 6 (20.0%) eyes of rest 10 eyes found deteriorated vision. Epithelialization occurred in all eyes. Twenty-four (80.0%) eyes had limbal stem cell deficiency and they experienced superficial corneal vascularization. Symblepharon was seen in 18 (60.0%) eyes, 6 (20.0%) of these 18 eyes developed marked conjunctival shortening with ankyloblepharon. None of the eyes showed perforation. Conclusions: AMT increases patient comfort and reduces inflammation. In mild burns, AMT alone restores corneal and conjunctival surfaces. In moderate to severe burns, it reduces conjunctival scarring sequelae, but does not prevent the sequelae of limbal stem cell deficiency that requires further limbal stem cell transplantation. In the acute stage, AMT has a protective role against the progressive melting and perforation. J.Natl.Inst.Ophthalmol.2023;6(1): 21-26
Symblepharon
Chemical burn
Limbal stem cell
Perforation
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(1) Background: To evaluate the efficacy of conjunctival limbal autograft (CLAU) combined with the amnion-assisted conjunctival epithelial redirection (ACER) procedure for patients with unilateral total limbal stem cell deficiency (LSCD) caused by severe chemical burn. (2) Methods: A retrospective interventional case series of unilateral total LSCD after chemical burn who underwent CLAU combined with ACER surgery between September 2021 and July 2023 was collected. Outcome measures included epithelialization of the cornea with donor limbus-derived epithelium, best corrected visual acuity (BCVA), and complications. (3) Results: Nine males and one female were included in this study. The mean age was 40.9 ± 9.63 (range, 26 to 55) years. The average duration between injury and CLAU combined with the ACER procedure was 7.67 ± 3.97 (range, 4 to 18) months. All patients achieved corneal epithelialization and improved BCVA. Postoperative complications occurred in four cases, including delayed corneal epithelial healing in one case, delayed amniotic membrane dissolution and detachment in two cases, and recurrence of symblepharon in one case. No complications were noted in the healthy donor eyes. (4) Conclusions: CLAU combined with ACER is a safe and effective treatment for unilateral total LSCD caused by severe chemical burn. This combined surgery restores visual function for patients with corneal blindness caused by chemical burn, reducing the burden on the families and society.
Symblepharon
Chemical burn
Amnion
Limbal stem cell
Graft rejection
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Symblepharon
Chemical burn
Limbal stem cell
Corneal Neovascularization
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Introduction: Chemical burns of the eyes are one of the important causes of visual disability. Chemical burns particularly alkali burn may lead to gross limbal stem cell deficiency. Amniotic membrane transplantation with limbal graft is a good method for ocular surface reconstruction. Case: A 39 years male presented to Biratnagar Eye Hospital after 5 months of chemical injury with redness, pain, photophobia and gradual loss of vision. His visual acuity was counting fingers close to face in both eyes. Amniotic membrane transplantation alone was done in right eye while in left eye limbal stem cell allograft was combined with amniotic membrane transplantation. There was not much visual improvement in right eye while left eye improved significantly to 6/60.Conclusion: Limbal stem cell graft with amniotic membrane transplantation can be an effective method of restoring vision and reducing symptoms rather than amniotic membrane transplantation alone in cases with total limbal stem cell deficiency following chemical burn.
Limbal stem cell
Photophobia
Chemical burn
Symblepharon
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Symblepharon
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Citations (19)
Objective To evaluate the clinical efficacy of fresh human amniot-ic membrane transplantation for ocular surface reconstruction. Methods 76 patients(76 eyes) with various ocular surface diseases were treated for ocular surface reconstruction with transplantation of fresh human amniotic membrane. 2 patient with severe alkali chemical burn combined with corneal ulcer and deficiency of limbal stem cell,8 patients with bullous keratitis, 4 patients with corneal ulcer, 1 eye with severe symblepharon, 61 patients with pteygia (4 patients of them was recurrent). Results No acute rejection was observed after fresh amniotic membrane transplantation. No progressive melt and perforation were seen in two eyes, neovas-cularization, pseudopterygium and iris atrophy were not forund during the follow - up, visual acuity was improved in various degrees. 8 patients with bullous keratitis were successful, corneal ulcer was successful in 4 cases (4 eyes). Ocular surface reconstruction was successful in the eyes with severe symblepharon. Pterygium was successful in 57 of 61 cases. Conclusion Fresh amniotic membrane can be used as a graft to reconstruct ocular surface. Such transplantation can effectively reduce neovasculariza-tiori,fibrosis and inflammation. Our data indicated that complete removal of pathological tissues and perfect fixation of amniotic membrane graft are crucial steps in the reconstruction of ocular surface.
Symblepharon
corneal ulcer
Amnion
Limbal stem cell
Chemical burn
Corneal perforation
Bullous keratopathy
Perforation
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Objective:To study the feasibility,operative method and therapeutic efficacy of fresh amniotic membrane transplantation (AMT) in late complications of ocular surface burn.Methods:Eighteen eyes of 18 patients with late complications of ocular surface burn were subjected to AMT via single layer and multilayer AMT or combined reconstruction of eyelid and corneal limbal stem transplantation;eight patients had corneal pannus,seven had corneal ulcer and three had symblepharon.All patients were followed up for 6 12 months.Results:Acute rejection did not occur in all patients.Epithelium healed above all corneal ulcers within 4 6 weeks.Seventeen patients were cured,and visual acuity was improved in 13 patients.Conclusion:Fresh AMT is useful for treating late complications of ocular surface burn.
Symblepharon
Chemical burn
Pannus
Limbal stem cell
Thermal burn
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