The application of human amniotic membrane in the surgical management of limbal stem cell deficiency

Abstract

The application of human amniotic membrane (AM) has a wide spectrum of indications in the treatment of ocular surface disorders. Transplantation of AM has been incorporated routinely as a component of ocular surface reconstruction in a variety of ocular pathologies. The application of human AM can be combined with nearly all types of limbal transplantation in treating limbal stem cell deficiency (LSCD). AM provides support and possible protection to the transplanted limbal tissues and limbal stem cells owing to its mechanical and biological properties, and these properties are thought to enhance the success rate of LSC transplantation. This paper reviews the current literature on the applications of AM in the surgical management of LSCD and summarizes the outcome of different surgical approaches. The current literature contains mostly low-level evidences in supporting the role of AM. The efficacy of AM in LSC transplantation needs to be confirmed by randomized controlled clinical trials.

Figure 1.

Schematic diagram of amniotic membrane transplantation (AMT) alone (A) and combination of direct limbal transplantation with AMT (B to D). In AMT alone procedure, AM depicted in blue is placed over the denuded cornea, limbus and conjunctiva (A). When combined with limbal stem cell transplantation, AM is either serving as a graft under the limbal tissues depicted in red (B), or as a patch covering the limbal tissues (C). In “Sandwich” technique, AM is placed both beneath and on top of the limbal grafts. The AMs beneath and on top of the limbal tissues are labeled as blue and orange, respectively (D).

Figure 2.

Schematic diagram of different surgical techniques of SLET In a standard SLET (A), AM depicted in blue is placed on top of the ocular surface and donor limbal biopsy explants depicted in red are secured on AM. In a modified SLET (B), donor limbal biopsy explants are placed on the bared cornea surface and AM covers the limbal grafts and the entire corneal surface. The technique in which AMs are both used beneath (blue) and on top of (orange) the limbal tissues is called “Sandwich” technique (C).