Annular amniotic membrane and autologous limbal transplantation after chemical burn

ABSTRACT: In limbal stem cell deficiency (LSCD), limbic cells are unable to maintain corneal epithelium integrity. Patients with LSCD may suffer recurrent ulceration, chronic inflammation and loss of visual acuity due to the replacement of normal corneal epithelium by conjunctival epithelium. A 60-year-old male with LSCD after a chemical burn with cement (alkali) in the left eye 15 years ago complained of progressive visual loss. The left eye showed a dull cornea with loss of transparency due to conjunctivalization of the entire cornea. LSCD was diagnosed and limbal autograft plus amniotic membrane transplantation was proposed. During the procedure, the corneal stroma was transparent, so the central six millimeters were left free of amniotic membrane. Amniotic membrane graft can cause loss of corneal transparency that can last for several months. If the central corneal stroma is transparent and regular, the transient interim opacity can be avoided by annular amniotic membrane transplantation, thus speeding up recovery of visual acuity