Modified Simple Limbal Epithelial Transplantation Using Cryopreseryed Amniotic Membrane for Unilateral Limbal Stem Cell Deficiency

PURPOSE: To report the results of simple limbal epithelial transplantation using a double-layered cryopreserved amniotic membrane graft for the management of unilateral limbal stem cell deficiency. DESIGN: Retrospective case series. METHODS: Four consecutive patients with unilateral partial (2 eyes) and total (2 eyes) limbal stem cell deficiency secondary to ocular surface burns (2 eyes), trauma (1 eye) and conjunctival melanoma treatment (1 eye) underwent modified simple limbal epithelial transplantation at Bascom Palmer Eye Institute. Preoperative and postoperative visual acuity and quality of corneal epithelium were evaluated. RESULTS: The patients were followed up for a mean +/- standard deviation of 7.5 +/- 1.3 months. The donor eye returned to a healthy state in all patients. All patients had significant improvement in visual Acuity and resolution of ocular pain in the affected eye. Regular corneal epithelium and a quiet ocular surface were obtained in all patients by a median of 4 weeks. CONCLUSIONS: Compared with the currently used surgical techniques for management of limbal stem cell deficiency, simple limbal epithelial transplantation seems to be a safe, reproducible, and effective alternative. The use of a double layer allows more protection for the explant without impacting outcomes. Also, the use of cryopreserved amniotic membrane allows surgeons to perform this procedure in the Unites States. More cases with longer follow-up will be needed to assess the outcomes further. (C) 2014 by Elsevier Inc. All rights reserved.