Original articleOral Mucosal Graft With Amniotic Membrane Transplantation for Total Limbal Stem Cell Deficiency
Section snippets
Patients and Methods
We retrospectively reviewed the medical records of 7 eyes of 7 patients (4 male and 3 female) with total limbal stem cell deficiency, all confirmed by impression cytology.8 The mean age was 41.9 ± 15 years (range, 24 to 65). The etiology of limbal stem cell deficiency included chemical burn (4 eyes), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) (1 eye), ocular cicatricial pemphigoid (1 eye), and multiple cryotherapies and application of mitomycin C (MMC) for conjunctival
Results
Limbal stem cell deficiency was confirmed by impression cytology in all eyes, among which 6 were bilateral while 1 was unilateral. Complete conjunctivalization of the entire limbus was observed with the presence of goblet cells in the central cornea. Chronic ocular inflammation (Figure 2, Pre-op) was graded as severe in 1 eye, moderate in 5 eyes, and mild in 1 eye. Corneal vascularization (Figure 2, Pre-op) was detected in all 7 eyes with grade 2 in 1 eye, grade 3 in 2 eyes, and grade 4 in 4
Discussion
This study demonstrated that oral mucosal graft is a viable alternative to restore corneal surfaces suffering from total limbal stem cell deficiency. Symptomatic relief and a stable ocular surface with minimal inflammation and improved corneal clarity and visual acuity were achieved in all 7 eyes during the follow-up of 30 ± 19.8 months.
To circumvent the risk of allograft rejection and potential side effects of systemic immunosuppression by either keratolimbal allograft from cadavers or limbal
Jingbo Liu, MD, PhD, received his medical degree from Weifang Medical College, and got his PhD at Sun Yat-Sen University, China. He worked in Wenzhou Medical College as an attending physician, and completed his fellowship in corneal and ocular surface diseases at Ocular Surface Center, Miami, Florida in 2010. He is currently pursuing postdoctoral training at Dyson Vision Research Institute, Weill Cornell Medical College, New York, New York.
His research interests focus mainly on limbal stem
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Midterm results of conjunctival reconstruction with buccal mucosa and amniotic membrane after resecting ocular surface squamous neoplasia of the fornix
2023, Canadian Journal of OphthalmologyCitation Excerpt :After excising a widely extended conjunctival tumour, the challenge comes when needing to reconstruct the lost conjunctiva. The reconstruction technique presented in this study, using amniotic membrane for the bulbar conjunctiva13,15,16,26 and buccal mucosa for the tarsal conjunctiva,17–20,24 provides an adequate option for preserving the globe and its function. Table 8 shows the alternative options for conjunctival reconstruction.
Simple oral mucosal epithelial transplantation (SOMET) for ocular surface reconstruction in Stevens-Johnson Syndrome: A case report
2023, International Journal of Surgery Case ReportsLabial mucosal epithelium grafting in an ex vivo human donor cornea model
2022, Experimental Eye ResearchCitation Excerpt :The study findings have also confirmed the capability of the oral mucosal epithelium grafting for re-epithelization of the cornea. In the study, the surgical protocol introduced by Liu et al. (2011) was utilized for oral mucosal epithelial graft generation by dissecting the substantia propria, and the resulting grafts produced cellular epithelium outgrowths in established ex vivo model. The grafts in the study were from patients without any immune-mediated and/or hereditary diseases.
Recovering vision in corneal epithelial stem cell deficient eyes
2019, Contact Lens and Anterior EyeCitation Excerpt :The amniotic membrane, itself, is basically a thin connective tissue, which is possessed of its own epithelium. Some researchers favour leaving the amniotic epithelium intact when expanding limbal epithelial cells on amniotic membrane, which is claimed to promote a corneal epithelial phenotype [25]. Other groups, in contrast, recommend its removal to likely facilitate better epithelial adherence [26–28], and this tends to be the common contemporary approach.
Diagnostic criteria for limbal stem cell deficiency—a systematic literature review
2017, Survey of OphthalmologyCitation Excerpt :We also searched for and extracted data from earlier articles published between 1989 and 2000 as a reference. In total, we found 46 articles1,4–7,9,10,23,26,27,29,33–35,37,40,42,46,47,49,50,52–55,58,59,65,67,69,70,72–79,83–85,88–90,100 that fulfilled the search criteria (Fig. 1). Out of the studies, 32 were retrospective studies, 9 were prospective, 4 did not fall into these categories clearly, and 1 was a case report.
Jingbo Liu, MD, PhD, received his medical degree from Weifang Medical College, and got his PhD at Sun Yat-Sen University, China. He worked in Wenzhou Medical College as an attending physician, and completed his fellowship in corneal and ocular surface diseases at Ocular Surface Center, Miami, Florida in 2010. He is currently pursuing postdoctoral training at Dyson Vision Research Institute, Weill Cornell Medical College, New York, New York.
His research interests focus mainly on limbal stem cell, amniotic epithelial stem cell, tissue engineering and corneal wound healing after injury.
Matthew Giegengack is currently practicing at the Department of Ophthalmology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.