Surgical Procedure for Treating Total Unilateral LSCD using a Conjunctival Limbal Autograft (CLAU) and Amniotic Membrane Transplantation (AMT)

Unilateral total LSCD treated with superficial keratectomy CLAU & AMT
            Before treatment                    After treatment

Surgical Procedure for CLAU and AMT:

  1. Perform limbal peritomy

  2. Remove the corneal pannus via blunt superficial keratectomy

  3. Polish the corneal surface with a dental burr (only if uneven).

  4. Perform amniotic membrane transplantation using fibrin glue to cover the affected corneal surface and the bare sclera (as a Permanent graft - which allows the host cells to proliferate over the membrane). Spare the visual axis if the remaining corneal stroma is smooth and clear centrally by opening a 6 mm diameter window on AM.

  5. Harvest a conjunctival limbal graft (CLAU) from the fellow eye consisting of a limbal arc length of 6 mm (about 60° of limbus), with 1 mm of peripheral cornea and 8 mm of the conjunctiva.11 [A recent report showed that one such strip is sufficient]

  6. Secure this free CLAU graft to the limbal area of the affected eye by interrupted 10-0 nylon sutures over the pre-placed amniotic membrane.

  7. Cover the resulting bare area in the donor eye by cryopreserved amniotic membrane using fibrin glue

  8. Insert PROKERA® to cover the cornea and the limbal graft (as Temporary patch graft). The benefits of cryopreserved amniotic membrane will then be delivered through this sutureless conformer ring, which protects the cornea and the graft from external trauma while exerting biologic supportive functions to all covered parts of the ocular surface.

Click here to view a video showing the surgical treatment of Total Unilateral LSCD with CLAU and AMT.

 


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