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Management of limbal stem cell deficiency by amnion-assisted conjunctival epithelial redirection (ACER) using vacuum dried amniotic membrane and fibrin glue

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First Author: D.Ting UK

Co Author(s):    D. Said   H. Dua                 

Abstract Details

Purpose:

To examine the outcome of a modified amnion-assisted conjunctival epithelial redirection (ACER) technique using vacuum dried amnion (Omnigen®) and fibrin glue for managing total limbal stem cell deficiency (LSCD).

Setting:

A retrospective, interventional case series at a UK tertiary referral centre.

Methods:

We included a total of 10 patients (6 male, 4 female, mean age of 46.2±18.4 years) in this study. All included patients were diagnosed with total LSCD and underwent limbal stem cell transplant (LSCT) using the modified ACER procedure at Queen’s Medical Centre, Nottingham, UK, between 2016 and 2019. The outcome was defined as: (1) Success: complete corneal epithelialisation without conjunctivalisation / LSCD; (2) Partial success: complete corneal epithelialisation with partial conjunctivalisation / LSCD sparing the visual axis; and (3) Failure: conjunctivalisation / LSCD affecting the visual axis.

Results:

The mean follow-up duration was 21.4±15.5 months. Causes of LSCD were chemical eye injury (30%), congenital aniridia-related keratopathy (30%), ocular surface malignancy (20%), Steven-Johnson syndrome (10%), and contact lens overuse (10%). Half (50%) of the cases were unilateral and the remainder were bilateral. The time from diagnosis to ACER (for acquired causes) was 45.6±44.4 months. Eight (80%) patients achieved a complete/partial success following ACER and two patients required repeat LSCT. Auto-LSCT was associated with a significantly higher chance of success than allo-LSCT (p=0.048). The mean BCVA (logMAR) improved significantly from 1.76±0.64 preoperatively to 0.94±0.94 at final follow-up (p=0.009).

Conclusions:

LSCT using the modified ACER serves as an effective ocular surface reconstruction technique in managing total LSCD and improving vision. Vacuum dried amnion provides advantages of easy handing, transparency and storage at room temperature.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented