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N. Zakaria, C. Koppen, V. V. Tendeloo, Z. Berneman, M. J. Tassignon; Surgical Advancements in Cultivated Limbal Stem Cell Transplantation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1789.
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To describe a novel, sutureless, ‘No Touch’ surgical method utilizing the ‘Amnion Ring’ which reduces surgical time and provides wrinkle free cultivated-limbal-stem-cell graft attachment, ensuring minimal manipulation and better corneal integration.
The limbal stem cell graft, cultivated on an amniotic membrane secured to an inter-lockable amnion ring, can be removed from culture by grasping the plastic amnion ring with forceps and placing the whole construct onto the diseased eye in one fluid motion. The limbal biopsy is slightly decentered with respect to the pupil and is left in place. The graft is secured on the eye with fibrin glue and the required size cut out at the level of the limbus. A second amniotic membrane (AM) basement membrane faced down is placed on top of the graft and acts as a biological patch.
The lightweight plastic rings offer stability to the AM and allow it to be transferred onto the surgical field with correct orientation whilst keeping it immobile so that its required dimensions can be cut out using capsulorhexis scissors.
This method for stem cell transplantation is superior to methods currently in place since it prevents cell losses incurred due to manipulation during surgery. The limbal biopsy is not removed from the culture and is transplanted attached to the cultivated-limbal-stem-cell graft; ensuring a continued source of cells and permitting graft tracking in the post operative period.
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