title: Sutureless amniotic membrane transplantation for partial limbal stem cell deficiency.
abstract: OBJECTIVE
  To evaluate the results of sutureless amniotic membrane (AM) transplantation using fibrin glue for reconstructing corneal surfaces with partial limbal stem cell deficiency (LSCD).
  
  
  METHODS
  Retrospective noncomparative interventional case series.
  
  
  METHODS
  Eleven eyes of nine patients that had LSCD with 120 degrees to almost 360 degrees of limbal involvement underwent superficial keratectomy to remove the conjunctivalized pannus followed by AM transplantation using fibrin glue. Additional sutureless AM patch (ProKera; Bio-Tissue, Inc, Miami, Florida, USA) was used in seven patients, and mitomycin C was applied on the cornea in four eyes and during fornix reconstruction in seven eyes. The surgery was repeated in three eyes for residual pannus.
  
  
  RESULTS
  During a mean follow-up of 14.2 +/- 7.7 months (range, six to 26 months), all eyes maintained a smooth and stable corneal epithelial surface without recurrent erosion or persistent epithelial defect, and showed less stromal cloudiness and vascularization. Best-corrected visual acuity improved in nine eyes (81.8%). Corneal epithelialization proceeded by epithelial growth over AM (n = 4), accompanied by dissolution of AM (n = 4) or a combination of both (n = 3). No complication was noted regarding initial or repeated uses of fibrin glue.
  
  
  CONCLUSIONS
  AM transplantation using fibrin glue appears to be a safe and effective method of restoring a stable corneal epithelium for cases with partial LSCD. This approach avoids the need of transplanting limbal epithelial stem cells.
authors.affiliation: Ocular Surface Center, Miami, Florida 33173, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kheirkhah
authors.forename: Victoria
authors.initials: V
authors.lastname: Casas
authors.forename: Vadrevu K
authors.initials: VK
authors.lastname: Raju
authors.forename: Scheffer C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000637:transplantation*; D002648:Child; D003316:Corneal Diseases / Q000601:surgery*; D004847:Epithelial Cells / Q000473:pathology; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013234:Stem Cells / Q000473:pathology*; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives