Modified amnion-assisted technique shows efficacy in managing limbal stem cell deficiency
Modified amnion-assisted conjunctival epithelial redirection, using vacuum-dried amnion and fibrin glue, may be an effective ocular surface reconstruction technique in managing limbal stem cell deficiency and improving vision.
“Vacuum-dried amnion provides advantages of easy handling, better transparency and storage at room temperature, while the use of fibrin glue instead of sutures helps shorten intraoperative time and obviates suture-related complications and the need for removal postop,” Darren SJ Ting, MD, said at the virtual European Society of Cataract and Refractive Surgeons winter meeting.
Limbal stem cell deficiency (LSCD) is a difficult-to-treat condition that occurs as a consequence of damage to the limbus induced by chemical injuries, contact lens overwear, radiation, drug toxicity and other causes. Limbal stem cell transplantation (LSCT) may be an effective treatment, but recurrence of conjunctivalization often leads to treatment failure. To reduce the risk for conjunctivalization after LSCT, Dua and colleagues proposed some years ago the use of amnion-assisted conjunctival epithelial redirection. The original technique entailed removal of the fibrovascular pannus from the diseased cornea and suturing of two autologous or donor conjunctival-limbal grafts at 12 and 6 o’clock. A small amnion was then placed on the cornea and covered with a larger membrane, sutured to the conjunctiva.
“Modifications to the original technique include the use of vacuum-dried amnion (Omnigen) in place of the cryopreserved amnion and the use of fibrin glue instead of sutures,” Ting said.
This novel technique was evaluated in a retrospective interventional study conducted at Queen’s Medical Centre in Nottingham, U.K., between January 2016 and July 2020. Ten patients with total LSCD were included, with a mean follow-up of 21 months. Five had unilateral disease, and five had bilateral disease. Chemical eye injury and congenital aniridia were the most common cases. Preoperatively, 90% had 6/60 or worse vision.
“Autologous or allogenic LSCT was performed in an equal number of eyes. Complete success was achieved in 60% of the cases and partial success in 20%. The mean time from transplant to complete corneal re-epithelialization was 1 month. Auto-LSCT had a significantly higher chance of success. Vison improved in 70% of the cases,” Ting said.
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Ting DSJ. Management of limbal stem cell deficiency by amnion-assisted conjunctival epithelial redirection (ACER) using vacuum dried amniotic membrane and fibrin glue. Presented at: European Society of Cataract and Refractive Surgeons winter meeting; Feb. 19-21, 2021 (virtual meeting).
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