Allogeneic simple limbal epithelial transplantation: an appropriate treatment for bilateral stem cell deficiency

2021 ◽  
Vol 14 (2) ◽  
pp. e239998
Author(s):  
Amanjot Kaur ◽  
Zeeshan Jamil ◽  
Smruti Rekha Priyadarshini
Keyword(s):  
Stem Cell ◽  
Ocular Surface ◽  
Limbal Stem Cell Deficiency ◽  
Chemical Injury ◽  
Appropriate Treatment ◽  
Limbal Stem Cell ◽  
Living Related ◽  
Topical Medications ◽  
Surface Inflammation ◽  
Ocular Surface Inflammation

A 39-year-old man presented with both eyes limbal stem cell deficiency status post chemical injury. He was managed initially with topical medications to subside the ocular surface inflammation. Over the course of subsequent visits, the fibrovascular pannus over the cornea gradually progressed, leading to further diminution of vision in left eye more than right eye. Since, the ocular surface was wet, the patient committed for lifelong immunosuppression and his brother consented to donate healthy limbal tissue; he underwent living-related allogeneic simple limbal epithelial transplantation in the left eye.

scholarly journals Midterm outcomes of penetrating keratoplasty following allogeneic cultivated limbal epithelial transplantation in patients with bilateral limbal stem cell deficiency

2021 ◽  
Vol 14 (11) ◽  
pp. 1690-1699
Author(s):  
Jun-Fa Xue ◽  
◽  
Ya-Ni Wang ◽  
Chen Chen ◽  
Ru-Fei Yang ◽  
...  
Keyword(s):  
Stem Cell ◽  
Graft Survival ◽  
Graft Rejection ◽  
Ocular Surface ◽  
Penetrating Keratoplasty ◽  
Limbal Stem Cell Deficiency ◽  
Time Interval ◽  
Case Series Study ◽  
Limbal Stem Cell ◽  
Cultivated Limbal Epithelial Transplantation

AIM: To evaluate the midterm outcomes of penetrating keratoplasty (PK) following allogeneic cultivated limbal epithelial transplantation (CLET) for bilateral total limbal stem cell deficiency (LSCD). METHODS: Ten patients (10 eyes) with bilateral LSCD were enrolled in this prospective noncomparative case series study. Each participant underwent PK approximately 6mo after a CLET. Topical tacrolimus, topical and systemic steroids, and oral ciclosporin were administered postoperatively. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular surface grading scores (OSS), corneal graft epithelial rehabilitation, persistent epithelial defect (PED), immunological rejection, and graft survival rate were assessed. RESULTS: The time interval between PK and allogeneic CLET was 6.90±1.29 (6-10)mo. BCVA improved from 2.46±0.32 logMAR preoperatively to 0.77±0.55 logMAR post-PK (P<0.001). Kaplan-Meier analysis of mean graft survival revealed graft survival rates of 100% at 12 and 24mo and 80.0% at 36mo. PEDs appeared in 5 eyes at different periods post-PK, and graft rejection occurred in 4 eyes. The total OSS decreased from 12.4±4.4 before allogeneic CLET to 1.4±1.51 after PK. CONCLUSION: A sequential therapy design of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite the relatively high graft rejection rate.

Long-term Outcomes of Living-Related Conjunctival Limbal Allograft Compared With Keratolimbal Allograft in Patients With Limbal Stem Cell Deficiency

Cornea ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Albert Y. Cheung ◽  
Medi Eslani ◽  
Khaliq H. Kurji ◽  
Elizabeth Wright ◽  
Enrica Sarnicola ◽  
...  
Keyword(s):  
Stem Cell ◽  
Limbal Stem Cell Deficiency ◽  
Long Term Outcomes ◽  
Keratolimbal Allograft ◽  
Limbal Stem Cell ◽  
Living Related

scholarly journals Japan: Diagnosis and Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications

2021 ◽  
Vol 8 ◽  
Author(s):  
Chie Sotozono ◽  
Mayumi Ueta ◽  
Shigeru Kinoshita
Keyword(s):  
Stem Cell ◽  
Contact Lens ◽  
Ocular Surface ◽  
Disease Onset ◽  
Stevens Johnson Syndrome ◽  
Ocular Involvement ◽  
Chronic Stage ◽  
Rigid Contact ◽  
Surface Inflammation ◽  
Ocular Surface Inflammation

In 2005, the “Japanese Research Committee on Severe Cutaneous Adverse Reaction” (J-SCAR) presented the official “Diagnostic Criteria” for SJS/TEN, and the specific ocular findings are included in these very important criteria. In SJS/TEN cases involving ocular disorder, conjunctivitis often occurs prior to the onset of the high fever. In a Japanese survey, ocular involvement was observed in 77% of the cases, and the incidence of ocular sequelae increased depending on the score of the acute ocular severity findings. Pseudo-membrane formation and epithelial defects are considered to be high-risk signs of ocular sequelae. At the chronic stage, limbal stem cell deficiency, visual disturbance, and severe dryness of the ocular surface are the primary disease characteristics. In 2002, we started performing Cultivated Oral Mucosal Epithelial Transplantation (COMET) for the treatment of severe ocular disorders, including SJS/TEN. As an additional treatment method, we developed a new type of rigid contact lens (CL) that is 13 to 14.0-mm in diameter, known as the “Limbal Rigid Contact Lens (Limbal CL).” Our Limbal Rigid CL greatly enhances the postoperative outcome of COMET. The detection rate of ocular surface bacteria is high in SJS/TEN cases. Thus, appropriate use of topical antibiotics reduces the risk of ocular surface inflammation. Moreover, rebamipide is an ophthalmic solution for dry eye that was developed in Japan, and it also has the effect of suppressing ocular surface inflammation. From disease onset until the chronic stage, the control of inflammation and stem cell loss is key to successfully treating eyes afflicted with SJS/TEN.

Keratolimbal allograft for limbal stem cell deficiency after severe corneal chemical injury: a systematic review

2017 ◽  
Vol 102 (8) ◽  
pp. 1114-1121 ◽  
Author(s):  
Swapna S Shanbhag ◽  
Hajirah N Saeed ◽  
Eleftherios I Paschalis ◽  
James Chodosh
Keyword(s):  
Systematic Review ◽  
Stem Cell ◽  
Best Practice ◽  
Limbal Stem Cell Deficiency ◽  
Cochrane Library ◽  
Systematic Review Methodology ◽  
Chemical Injury ◽  
Keratolimbal Allograft ◽  
Limbal Stem Cell

PurposeTo review the published literature on outcomes of keratolimbal allograft (KLAL) for the surgical treatment of limbal stem cell deficiency (LSCD) and corneal blindness after severe corneal chemical injury.MethodsLiterature searches were conducted in the following electronic databases: MEDLINE, EMBASE, Science Citation Index, CINAHL, LILACS and the Cochrane Library. Standard systematic review methodology was applied. The main outcome measure was the proportion of eyes with best-corrected visual acuity (BCVA) ≥20/200 at last follow-up. Other measures of allograft success were also collected.ResultsWe identified six reports in which KLAL outcomes in the eyes after chemical injury could be distinguished. There were no randomised controlled studies. The outcomes of KLAL in 36 eyes of 33 patients were analysed. One study with seven eyes did not specify KLAL follow-up specific to chemical injury. Median postoperative follow-up for the other 29 eyes in 26 patients was 42 months (range 6.2–114 months). In the same 29 eyes, 69% (20/29) had BCVA ≥20/200 at the last follow-up examination. Eighty-nine per cent of all eyes (32/36) underwent penetrating keratoplasty simultaneous or subsequent to KLAL.ConclusionsThe number of studies where outcomes of KLAL in eyes with severe corneal chemical injury could be discerned was limited, and variability was observed in outcome reporting. The quality of evidence to support the use of KLAL in LSCD in severe chemical corneal burns was low. Standardisation and longer follow-up are needed to better define evidence-based best practice when contemplating surgical intervention for blindness after corneal chemical injury.PROSPERO registration numberCRD42017054733.

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