Purpose To study the outcome of a modified amnion-assisted conjunctival epithelial redirection (ACER) technique using vacuum-dried amnion (Omnigen) and fibrin glue for managing total limbal stem cell deficiency (LSCD). Method A retrospective, interventional case series of all patients with total LSCD who underwent limbal stem cell transplant (LSCT) using the modified ACER procedure between 2016 and 2019. The outcome was defined as: (1) success: complete corneal re-epithelialisation without conjunctivalisation; (2) partial success: sub-total corneal re-epithelialisation with partial non-progressive conjunctivalisation sparing the visual axis and (3) failure: conjunctivalisation affecting the visual axis. Results Ten patients (six men), with a mean age of 46.2±18.4 years, were included. The mean follow-up was 23.0±13.9 months. Causes of LSCD were chemical eye injury (30%), congenital aniridia-related keratopathy (30%), ocular surface malignancy (20%), Steven-Johnson syndrome (10%) and contact lens overuse (10%). 50% were bilateral. The time from diagnosis to ACER (for acquired causes) was 45.6±44.4 months. 80% of patients achieved a complete/partial success following ACER and 20% of patients required repeat LSCT. Auto-LSCT was associated with a significantly higher chance of success than allo-LSCT (p=0.048). The mean best-corrected-visual-acuity (logMAR) improved significantly from 1.76±0.64 preoperatively to 0.94±0.94 at final follow-up (p=0.009). Omnigen was available off-the-shelf stored at room temperature and its transparency enabled visualisation of the healing epithelium beneath. Conclusion LSCT using the modified ACER serves as an effective ocular surface reconstruction technique in managing total LSCD and improving vision. Vacuum-dried amnion provides advantages of easy handling, transparency and storage at room temperature. Data are available upon reasonable request. Individual patient data are stored in the hospital’s electronic system and can be retrieved on reasonable request.

中文翻译：

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使用真空干燥羊膜和纤维蛋白胶通过羊膜辅助结膜上皮重定向治疗角膜缘干细胞缺乏症

目的研究使用真空干燥羊膜 (Omnigen) 和纤维蛋白胶改良羊膜辅助结膜上皮重定向 (ACER) 技术治疗全角膜缘干细胞缺乏症 (LSCD) 的结果。方法 对 2016 年至 2019 年间使用改良 ACER 手术进行角膜缘干细胞移植 (LSCT) 的所有全 LSCD 患者进行回顾性介入病例系列研究。结果定义为：(1) 成功：完全角膜再上皮化，无结膜化; (2) 部分成功：部分角膜再上皮化，部分非进行性结膜化，保留视轴；(3) 失败：影响视轴的结膜化。结果 10 名患者（6 名男性）被纳入，平均年龄为 46.2±18.4 岁。平均随访时间为 23.0±13.9 个月。LSCD 的原因是化学性眼损伤 (30%)、先天性无虹膜相关角膜病变 (30%)、眼表恶性肿瘤 (20%)、Steven-Johnson 综合征 (10%) 和隐形眼镜过度使用 (10%)。50% 是双侧的。从诊断到 ACER（获得性原因）的时间为 45.6±44.4 个月。80% 的患者在 ACER 后取得了完全/部分成功，20% 的患者需要重复 LSCT。Auto-LSCT 的成功几率明显高于 allo-LSCT (p=0.048)。平均最佳矫正视力 (logMAR) 从术前的 1.76±0.64 显着提高到最终随访时的 0.94±0.94 (p=0.009)。Omnigen 是现成的，可在室温下储存，其透明性使下方正在愈合的上皮细胞可视化。结论 使用改良 ACER 的 LSCT 可作为一种有效的眼表重建技术来管理全 LSCD 和改善视力。真空干燥羊膜具有易于处理、透明和室温储存的优点。可根据合理要求提供数据。个别患者数据存储在医院的电子系统中，可以根据合理要求进行检索。