Amniotic Membrane Transplanted in Conjunctiva as a Mesenchymal Stem Cells Carrier for Limbal Stem Cell Deficiency

ABSTRACT

PURPOSE: To report the use of amniotic membrane (AM) as a mesenchymal stem cell (MSC) carrier in cornea perforation with severe limbal stem cell deficiency due to a chemical burn on both eyes. CASE SUMMARY: The patient in the present study is a 43-year-old man with a history of bilateral alkaline chemical injury six years previously. The patient suffered from total limbal stem cell deficiency (LSCD) in the injured eyes and underwent numerous operations including autologous conjunctival flap, AM graft, penetrating keratoplasty, keratolimbal autograft and ex vivo expanded limbal allogrft. However, the patient's ocular condition deteriorated due to persistent LSCD, which led to corneal perforation resulting in the need for an urgent therapeutic operation. In the patient's past ocular history, Ahmed valve implantation was performed for uncontrolled IOP. Revision of the Ahmed tube due to exposure and conjunctival erosion was performed again via placement of an AM over the exposed tube one year previous to presentation to our hospital. The authors performed a transplanted AM graft at the cornea perforation using sub-conjunctival AM believed to contain MSCs. Six months postoperatively, the ocular surface was well mainatained and the graft remained healthy. Transplanted AM showed morphological and immunohistochemical findings similar to those of MSCs. CONCLUSIONS: Results from the present study confirm that AM transplanted into the conjunctiva is a useful carrier of bone marrow-derived MSCs in severe ocular surface diseases.