Amniotic Membrane Transplantation With or Without Limbal Allografts for Corneal Surface Reconstruction in Patients With Limbal Stem Cell Deficiency

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Abstract
WHEN pathologic insults destroy the stem cell–containing limbal epithelium, the corneal surface invariably heals with conjunctival epithelial ingrowth (conjunctivalization), neovascularization, chronic inflammation, and recurrent or persistent corneal epithelial defects.1 These pathologic signs constitute the newly established disease called limbal (stem cell) deficiency, which can be diagnosed by impression cytologic examination in a number of corneal diseases.2 These diseases can be subdivided into 2 major categories. The first category is characterized by total destruction of the limbal stem cell population by chemical or thermal injuries, the Stevens-Johnson syndrome, multiple surgical or cryotherapy procedures at the limbal region, contact lens wear, or severe microbial infection. The finding that such diseases cause limbal deficiency justifies the use of limbal autografts or allografts for corneal surface reconstruction.3-5 The second category includes such diverse diseases as aniridia, multiple endocrine deficiency, limbitis and peripheral ulcerative and inflammatory keratitis, neurotrophic and ischemic keratitis, and pterygium or pseudopterygium. These diseases do not destroy limbal stem cells directly but instead damage the limbal stroma so that it cannot support these stem cells.2