Amniotic
membrane transplantation seems to be useful
in the management of severe uniocular chemical
burns, according to A. John Kanellopoulos,
MD, who described his experience with the procedure.
He is an attending staff surgeon
at the Cornea Service, Manhattan Eye, Ear and
Throat Hospital, New York, and director of
External Diseases, Cornea, and Refractive Surgery
at the Ophthalmologic Center of Athens, Greece.
"Amniotic membrane transplantation
has been used in limbal stem cell deficiencies,
and several investigators have shown dramatic
improvement of monocular chemical injury using
limbal corneal stem cells from the patient's
fellow eye, " noted Dr. Kanellopoulos.
"Because many of these patients have been blind in one eye for years or decades,
we attempt to combine autologous limbal stem cell grafting with amniotic membrane
transplantation in the surgical management of severe ocular surface disease resulting
from uniocular chemical injury," he continued.
All eight patients underwent harvesting of
limbal stem cell autografts from the inferior
and superiosegments of the fellow healthy
eyes. The healthy eyes were anesthetized
with topical anesthesia and the injured
eye with peribulbar block.
The limbal
autografts (two 60° strips) were transplanted
onto the damaged eye, followed by transplantation
of the amniotic membrane and suturing with
8-0 Vicryl sutures. Re-formation of the superior
and inferior fornices is a challenging part
of the procedure, according to Dr. Kanellopoulos.
In addition
to the transplantation procedure, two patients
also underwent penetrating keratoplasty because
of dense, deep scarring of the cornea.
"The amniotic
membrane not only fosters the transplanted
limbal cells but also helps prevent symblepharon
formation between the palpebral and bulbar
conjunctiva," he said. |
