Management of limbal stem cell deficiency by amnion-assisted conjunctival epithelial redirection using vacuum-dried amniotic membrane and fibrin glue

2021 ◽  
pp. bjophthalmol-2020-318496
Author(s):  
Harminder Singh Dua ◽  
Darren Shu Jeng Ting ◽  
Ahmed AlSaadi ◽  
Dalia G Said
Keyword(s):  
Stem Cell ◽  
Fibrin Glue ◽  
Ocular Surface ◽  
Room Temperature ◽  
Limbal Stem Cell Deficiency ◽  
Visual Axis ◽  
The Mean ◽  
Limbal Stem Cell ◽  
Partial Success

PurposeTo 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).MethodA 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.ResultsTen 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.ConclusionLSCT 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.

scholarly journals Treatment of limbal stem cell deficiency with autologous cultivated oral mucosal epithelial transplantation

2019 ◽  
Author(s):  
yuqi jin ◽  
huicheng zhang ◽  
huimin wang ◽  
yufeng ye
Keyword(s):  
Stem Cell ◽  
Ex Vivo ◽  
Limbal Stem Cell Deficiency ◽  
Safe Alternative ◽  
Clinical Safety ◽  
The Mean ◽  
Limbal Stem Cell ◽  
Amniotic Membranes ◽  
Persistent Epithelial Defects

Abstract Background: To evaluate the feasibility of autologous cultivated oral mucosal epithelial transplantation (COMET) for the treatment of limbal stem cell deficiency (LSCD).Methods: Seven eyes from seven different patients with monocular LSCD were included in this study. Autologous oral mucosal epithelial cells were fabricated on ex vivo using amniotic membranes as a substrate. Clinical efficacy was evaluated by the coefficient of best-corrected visual acuity (BCVA). Clinical formation of the conjunctiva and symblepharon was evaluated and graded on a scale from 0 to 3. Clinical safety was evaluated by the presence of persistent epithelial defects, infection, and ocular hypertension.Results: Autologous COMET was successfully performed in all seven patients. The mean follow-up period was 10.7 months, during which time the postoperative formation of the conjunctiva and symblepharon was inhibited. BCVA was improved more than two lines in six eyes (86%) during the follow-up period. Complete reepithelialization of the corneal surfaces occurred in all treated eyes. No persistent epithelial defects, corneal infection, or postoperative ocular hypertension were observed. Conclusions: Autologous COMET offers a viable and safe alternative for the reconstruction of a stable ocular surface and improves vision in patients with LSCD.

scholarly journals Ocular surface squamous neoplasia in a young adult - its nature and unusual course

1970 ◽  
Vol 3 (2) ◽  
pp. 199-201
Author(s):  
A Panda ◽  
NK Sasikala
Keyword(s):  
Stem Cell ◽  
Ocular Surface ◽  
Past History ◽  
Surgical Excision ◽  
Limbal Stem Cell Deficiency ◽  
Impression Cytology ◽  
Ocular Surface Squamous Neoplasia ◽  
History Of ◽  
Limbal Stem Cell

Background: We describe a case o f a recurrent ocular surface squamous neoplasia (OSSN) in a 37-year-old male with a mass at the infero-temporal quadrant along with an isolated primary lesion at the upper nasal quadrant for the last five months with a past history of surgical excision 7 years ago for a nodular mass in the same eye. The mass showed delayed response to Mitomycin C (MMC) therapy and finally developed limbal stem cell deficiency. Case report: A 37-year-old male presented with a five-month history of foreign body sensation and localized conjunctival hyperemia and two progressively enlarging bumps over the limbus in the left eye. The past history stated a surgical excision, done 7 years ago, for a nodular mass in the same eye. A clinical diagnosis of recurrent OSSN was made, and confirmed by impression cytology. The patient received initial treatment with 0.02 % MMC, but did not show any improvement even after 3 cycles, but later showed marked chemoreduction with 0.04 % MMC on two cycles and a complete resolution of the neoplasia after two more cycles. Impression cytology at six months revealed no abnormality. But at the 10-month follow-up, limbal stem cell deficiency was observed. Conclusion: While examining, managing and follow-up of a case of OSSN, one needs to know the atypical nature and response of the tumour. Long-term follow-up in these cases is mandatory.DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5297 Nepal J Ophthalmol 2011; 3(2): 199-201 

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.

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.

scholarly journals Surgical Success Evaluation in Limbal Stem Cell Deficiency Due to Chemical Injury – How to Be Accurate?

2021 ◽  
Author(s):  
Ilayda Korkmaz ◽  
Melis Palamar ◽  
Sait Egrilmez ◽  
Mehmet Gurdal ◽  
Ayse Yagci ◽  
...  
Keyword(s):  
Stem Cell ◽  
Success Rate ◽  
Cell Transplantation ◽  
Limbal Stem Cell Deficiency ◽  
Grading System ◽  
Success Rates ◽  
Surgical Success ◽  
Chemical Injury ◽  
The Mean ◽  
Limbal Stem Cell

Abstract Purpose: To evaluate limbal stem cell transplantation (LSCT) success in limbal stem cell deficiency (LSCD) due to chemical injury in a tertiary eye care center in Turkey by using ‘Limbal Stem Cell Working Group’ LSCD grading system.Methods: Medical records of 80 eyes of 80 patients who underwent LSCT for LSCD secondary to chemical injury were included. The patients were divided into 3 groups according to performed surgery as limbal autograft, limbal allograft, cultivated limbal epithelial cell transplantation (CLET). Surgical success was defined as improvement in the post-operative 1st year LSCD stage.Results: The mean age of the patients was 37.9±15.7(4-71) with a Male/Female ratio of 2.4. Forty-five(56.3%) patients were injured with alkaline and 16(20%) were injured with acid substance. The mean follow-up time was 60.3±30.6(6-118.6) months. Limbal autograft, allograft and CLET were performed in 58(72.5%), 12(15%) and 10(12.5%) eyes, respectively. The interval between injury and surgery in limbal autograft, limbal allograft and CLET were 43.3±94.1(0.5-592); 14.5±10.6(2.4-32.5) and 122.8±158.9(21.1-504) months, respectively (p=0.02). The overall surgical success rate was 65%. Surgical success rates in each groups were 65.5%, 41.7% and 90%, respectively (p=0.03).Conclusion: It is vital to accurately determine the stage of the LSCD in order to evaluate the surgical success rates. Surgery type and a longer time interval between the chemical injury and surgery seems to be the most important factors associated with a higher surgical success rate. Despite the limited subject number for subgroups, the results were remarkable to emphasize the significance of the novel LSCD grading system.

scholarly journals PALT (Partial Allogeneic Limbal Transplantation): A New Surgical Technique For Limbal Stem Cell Deficiency

2021 ◽  
Author(s):  
Christiane Kesper ◽  
Anja Viestenz ◽  
Thomas Hammer ◽  
Joana Heinzelmann ◽  
Sabine Foja ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Stem Cell ◽  
Surgical Technique ◽  
Limbal Stem Cell Deficiency ◽  
Corneal Vascularization ◽  
Donor Graft ◽  
Limbal Stem Cell ◽  
New Surgical Technique ◽  
Limbal Transplantation

Abstract PurposeLimbal stem cell deficiency (LSCD) is a rare but extremely relevant disease of the eye. LSCD patients often require a variety of surgical procedures, including keratoplasty in some cases. However, the outcome of these surgeries, including opacification and revascularization, is often frustrating due to LSCD relapse.MethodsWe developed a new surgical technique for the treatment of LSCD in which partial allogenic limbal transplantation (PALT) is carried out as part of penetrating keratoplasty (PK). After the PK, 1-8 slices from the limbal tissue of the donor graft are prepared and placed under the double running sutures attaching the corneal graft. This procedure was performed on 14 patients with LSCD, caused by severe ocular burn in 5 cases and by infection in 9. Between one and eight limbal transplants were used depending on the extension of the LSCD. ResultsAll 14 patients showed stable or increased visual acuity after the PALT surgery compared to their preoperative visual acuity. All of the grafts were integrated into the superficial corneal layers without progression of corneal vascularization beyond the limbal grafts. The median follow-up period was 12 months on average.ConclusionThe PALT method seems to be a promising surgical procedure for the treatment of patients with LSCD. It can be properly carried out in the context of keratoplasty and does not require a separate donor tissue. The PALT grafts may offer the possibility of constructing a new limbal region, resulting in stable or even increased visual acuity and the absence of corneal vascularization.

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