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.

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 A Review of Limbal Stem Cell Deficiency

2019 ◽  
Vol 2 (1) ◽  
pp. e4-e11
Author(s):  
John E. Conto
Keyword(s):  
Stem Cell ◽  
Contact Lenses ◽  
Systemic Disease ◽  
Anterior Segment ◽  
Treatment Strategies ◽  
Limbal Stem Cell Deficiency ◽  
Contact Lens Wear ◽  
Limbal Stem Cell Transplantation ◽  
Limbal Stem Cell ◽  
Amniotic Membranes

Limbal stem cell deficiency (LSCD) can be secondary to multiple etiologies including contact lens wear, chemical or thermal trauma, and systemic disease, any of which can result in the reduction of the number of stem cells or their decreased functionality. Primary LSCD is seen with a variety of congenital anterior segment disorders. Often LSCD can be stabilized and timely diagnosis is the key. The use of topical corticosteroids and artificial tear lubricants, along with treatment of any underlying conditions, and discontinuation of contact lenses are important initial treatment strategies. Advance treatments include amniotic membranes, limbal stem cell transplantation and keratoprostheses.

Transplantation of Conjunctival Epithelial Cells Cultivated Ex Vivo in Patients With Total Limbal Stem Cell Deficiency

Cornea ◽  
2013 ◽  
Vol 32 (3) ◽  
pp. 221-228 ◽  
Author(s):  
José Reinaldo S. Ricardo ◽  
Priscila C. Cristovam ◽  
Pedro A. N. Filho ◽  
Charles C. Farias ◽  
Aline L. de Araujo ◽  
...  
Keyword(s):  
Stem Cell ◽  
Epithelial Cells ◽  
Ex Vivo ◽  
Limbal Stem Cell Deficiency ◽  
Limbal Stem Cell ◽  
Conjunctival Epithelial Cells

scholarly journals Successful Application of Ex Vivo Expanded Human Autologous Oral Mucosal Epithelium for the Treatment of Total Bilateral Limbal Stem Cell Deficiency

Stem Cells ◽  
2014 ◽  
Vol 32 (8) ◽  
pp. 2135-2146 ◽  
Author(s):  
Sai Kolli ◽  
Sajjad Ahmad ◽  
Hardeep Singh Mudhar ◽  
Adam Meeny ◽  
Majlinda Lako ◽  
...  
Keyword(s):  
Stem Cell ◽  
Ex Vivo ◽  
Limbal Stem Cell Deficiency ◽  
Mucosal Epithelium ◽  
Limbal Stem Cell

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.

scholarly journals Preserving Basement Membranes during Detachment of Cultivated Oral Mucosal Epithelial Cell Sheets for the Treatment of Total Bilateral Limbal Stem Cell Deficiency

2018 ◽  
Vol 27 (2) ◽  
pp. 264-274 ◽  
Author(s):  
Marie-Rose Rovere ◽  
Patricia Rousselle ◽  
Marek Haftek ◽  
Bruce Charleux ◽  
Viridiana Kocaba ◽  
...  
Keyword(s):  
Stem Cell ◽  
Vision Loss ◽  
Ex Vivo ◽  
Immunosuppressive Treatment ◽  
Basement Membranes ◽  
Limbal Stem Cell Deficiency ◽  
Type Vii Collagen ◽  
Limbal Stem Cell ◽  
The Impact ◽  
Limbal Transplantation

Total bilateral limbal stem cell deficiency leading to loss of corneal clarity, potential vision loss, pain, photophobia, and keratoplasty failure cannot be treated by autologous limbal transplantation, and allogeneic limbal transplantation requires subsequent immunosuppressive treatment. Cultured autologous oral mucosal epithelial cells have been shown to be safe and effective alternatives. These cells can be transplanted on supports or without support after detachment from the culture dishes. Dispase, known for epidermal sheet detachment, is reported as not usable for oral mucosa. The objective was to find an optimized detachment method providing a sufficiently resistant and adhesive cultured oral mucosal epithelium (COME), which can be grafted without sutures. Enzymatic treatments (dispase or collagenase at different concentrations) were compared to enzyme-free mechanical detachment. Histological immunofluorescence (IF) and Western blotting (WB) were used to examine the impact on adhesion markers (laminin-332, β1-integrin, and type VII collagen) and junctional markers (E-cadherin, P-cadherin). Finally, the COME ability to adhere to the cornea and produce a differentiated epithelium 15 d after grafting onto an ex vivo porcine stroma model were investigated by histology, IF, and transmission electron microscopy. Collagenase at 0.5 mg/mL and dispase at 5 mg/mL were selected for comparative study on adhesive expression marker by IF and WB showed that levels of basement membrane proteins and cell–cell and cell–matrix junction proteins were not significantly different between the 3 detachment methods. Collagenase 0.5 mg/mL was selected for the next step validation because of the better reproducibility, 100% success (vs. 33% with dispase 5 mg/mL). Grafted onto porcine de-epithelialized corneal stroma, collagenase 0.5 mg/mL detached COME were found to adhere, stratify, and continue to ensure renewal of the epithelium. For COME, collagenase 0.5 mg/mL enzymatic detachment was selected and validated on its resistance and adhesive marker expression as well as their anchorage onto our new ex vivo de-epithelialized stroma model.

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