Ocular Surface Transplantation and Amniotic Membrane Surgery
Issued Date
2022-01-01
Resource Type
Scopus ID
2-s2.0-85158967931
Journal Title
Albert and Jakobiec's Principles and Practice of Ophthalmology: Fourth Edition
Start Page
431
End Page
451
Rights Holder(s)
SCOPUS
Bibliographic Citation
Albert and Jakobiec's Principles and Practice of Ophthalmology: Fourth Edition (2022) , 431-451
Suggested Citation
Niparugs M. Ocular Surface Transplantation and Amniotic Membrane Surgery. Albert and Jakobiec's Principles and Practice of Ophthalmology: Fourth Edition (2022) , 431-451. 451. doi:10.1007/978-3-030-42634-7_216 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86213
Title
Ocular Surface Transplantation and Amniotic Membrane Surgery
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Ocular surface disease is a result of an imbalance of ocular surface protective mechanisms. Management of patients with ocular surface disease requires a systematic and stepwise approach to treatment. Surgical management of ocular disease using limbal stem cell transplantation (LSCT) is one of major technique to correct limbal stem cell deficiency (LSCD). The extension with laterality of LSCD and the involvement of conjunctiva effect the selection of the appropriate technique. Ex vivo tissue engineering is sometime necessary in case of limitation of donor stem cell. Conjunctival limbal autograft (CLAU) or simple limbal epithelial transplant (SLET) are procedures of choice for patient with unilateral LSCD. In bilateral total LSCD with conjunctival deficiency, living-related conjunctival limbal allograft (lr-CLAL) should be considered if patient-related donor tissue is available. Keratolimbal allograft (KLAL) is a good option for the cases that primarily affect the limbus with minimal involvement of the conjunctiva. The combination of a conjunctival limbal with keratolimbal allograft tissue (C-KLAL) can be used to manage eyes with severe conjunctival and limbal stem cell deficiency. Keratoprosthesis should be only reserved for the patients who have failed ocular surface transplantation and keratoplasty, or have contraindications for systemic immunosuppression because of lifetime risk of severe complication. Amniotic membrane transplantation (AMT) is also an accepted standard surgical procedure to treat ocular surface diseases. It can be used for the ocular surface reconstruction in various surgical techniques either as a permanent graft, as a temporary patch, or a combination of both. Amnion is also used in conjunction with other surgical procedures such as in LSCT as a substrate and carrier for cell cultivation.