Histopathology of human corneas after amniotic membrane and limbal stem cell transplantation for severe chemical burn.
OBJECTIVE
To describe the histopathologic changes in the cornea following amniotic membrane transplantation (AMT) combined with limbal transplantation.


METHODS
Four eyes with complete limbal stem cell deficiency after severe chemical burn underwent AMT with either a living-related conjunctival limbal allograft (lr-CLAL) (three eyes) or a conjunctival limbal autograft (CLAU) (one eye) for ocular surface reconstruction. Penetrating keratoplasty was performed several months after the initial procedure for further visual rehabilitation. Mean follow up time was 20 months. Light and transmission electron microscopy (TEM) and indirect immunofluorescence microscopy of the excised corneal buttons were performed.


RESULTS
All specimens displayed a multilayered epithelium without conjunctival goblet cells over the entire corneal surface. Basal epithelial cells demonstrated a firm connection to the remnants of the transplanted amniotic membrane (AM), which at some places appeared to be in a state of "modification" or "remodeling" in the collagen layers. The basement membrane zone displayed a positive staining when using antibodies against collagen IV and VII, integrin alpha6 and beta4, laminin 5, and bullous pemphigoid antigen 2. Remnants of the AM in the specimen showed staining of collagen IV, which was found also in cross-sections of cryopreserved AM. The recipients Bowman's membranes that were only partially present after the initial trauma were significantly disturbed.


CONCLUSIONS
Within the time frame studied, the transplanted AM apparently survives and integrates into the host tissue being modified or remodeled by recipient cells. AMT in combination with a CLAU or lr-CLAL is a useful technique in promoting a rapid and stable reepithelialization of a corneal surface following severe chemical or thermal damage.
Stoiber
Josef
J
Department of Ophthalmology and Optometry, St. Johanns-Spital, Landeskliniken Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria. j.stoiber@lks.at
Muss
Wolfgang H
WH
Pohla-Gubo
Gabriele
G
Ruckhofer
Josef
J
Grabner
Günther
G
D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000637:transplantation*; D015415:Biomarkers / Q000032:analysis; D002057:Burns, Chemical / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D017690:Cell Transplantation; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000166:cytology* / Q000378:metabolism / Q000648:ultrastructure; D003315:Cornea / Q000378:metabolism / Q000473:pathology*; D004847:Epithelial Cells / Q000378:metabolism / Q000637:transplantation* / Q000648:ultrastructure; D016326:Extracellular Matrix Proteins / Q000378:metabolism; D005126:Eye Burns / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000378:metabolism / Q000648:ultrastructure
D015415:Biomarkers; D016326:Extracellular Matrix Proteins