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 Quantitative Analysis of the Association Between Follow-Up Duration and Severity of Limbal Stem Cell Deficiency or Visual Acuity in Aniridia

2020 ◽  
Vol 61 (6) ◽  
pp. 57
Author(s):  
Shimpei Komoto ◽  
Yoshinori Oie ◽  
Satoshi Kawasaki ◽  
Ryo Kawasaki ◽  
Nozomi Nishida ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Stem Cell ◽  
Quantitative Analysis ◽  
Limbal Stem Cell Deficiency ◽  
Limbal Stem Cell

scholarly journals Limbal Stem Cell-Sparing Corneoscleroplasty with Peripheral Intralamellar Tuck: A New Surgical Technique for Keratoglobus

2017 ◽  
Vol 8 (1) ◽  
pp. 279-287
Author(s):  
Elias Jarade ◽  
Rafic Antonios ◽  
Sylvain el-Khoury
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Structural Integrity ◽  
Single Step ◽  
Limbal Stem Cells ◽  
Host Cornea ◽  
Limbal Stem Cell ◽  
The Right ◽  
New Surgical Technique

Purpose: To describe the technique of limbal stem cell-sparing corneoscleroplasty for the management of advanced keratoglobus. Methods: A patient with bilateral advanced keratoglobus, with best-corrected visual acuity of 20/400 in the right eye and 20/200 in the left eye, underwent limbal stem cell-sparing corneoscleroplasty of the right eye. Initially, a 360-degree limbal incision with 200-μm depth was created, followed by a sublimbal tunnel dissection into the sclera, in order to conserve stem cells. Next, a limbus-to-limbus lamellar keratectomy at 200-μm depth was performed. Meanwhile, a donor corneoscleral button with preserved endothelium of the central 8 mm was fashioned. Prior to suturing the donor corneoscleral graft using a modified suturing technique to cover its scleral component, a full-thickness trephination of 8-mm diameter was completed in the central host cornea. Results: Reepithelialization occurred within the first week. No episodes of rejection, intraocular pressure spikes, or epithelial breakdown were observed postoperatively. At the 6-month follow-up, the patient had 20/70 best-corrected vision and a smooth cornea with regular astigmatism on topography. Conclusion: Limbal stem cell-sparing corneoscleroplasty is a single-step technique for restoring the structural integrity of the cornea in advanced keratoglobus while preserving the host limbal stem cells.

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 Allo-limbal transplantation in patients with limbal stem cell deficiency

1999 ◽  
Vol 83 (12) ◽  
pp. 1409-1409 ◽  
Author(s):  
A. L YOUNG ◽  
A. T S LEUNG ◽  
D. S C LAM; ◽  
H. S DUA ◽  
A. AZUARA-BLANCO ◽  
...  
Keyword(s):  
Stem Cell ◽  
Limbal Stem Cell Deficiency ◽  
Limbal Stem Cell ◽  
Limbal Transplantation

scholarly journals Clinical outcomes of autologous cultured oral mucosal epithelium transplantation for treatment of limbal stem cell deficiency

2020 ◽  
pp. 77-85
Author(s):  
B.E. Malyugin ◽  
◽  
S.A. Borzenok ◽  
M.Y. Gerasimov ◽  
◽  
...  
Keyword(s):  
Clinical Trials ◽  
Visual Acuity ◽  
Stem Cell ◽  
Underlying Disease ◽  
Corneal Neovascularization ◽  
Limbal Stem Cell Deficiency ◽  
Complication Rates ◽  
Mucosal Epithelium ◽  
Ocular Surface Reconstruction ◽  
Limbal Stem Cell

The review presents an analysis of clinical trials results for autologous cultured oral mucosal epithelium transplantation (COMET) in patients with bilateral corneal limbal stem cell deficiency (LSCD) over the past 15 years. Detailed characteristics and evaluation are given for anatomical outcomes, visual acuity changes, and complication rates. The results obtained during the analysis confirm the consistency of the concept of corneal re-epithelization by means of COMET. COMET promoted persistent corneal re-epithelization in 81.5% of cases, and visual acuity improvement in 78.8% of patients with LSCD. COMET does not require systemic immunosuppression, and it is accompanied by much smaller numbers and significantly lower grades of complications compared with keratoprosthesis. About 15% of patients experienced developing superficial peripheral corneal neovascularization regressed spontaneously by 12 months of observation. Based on the COMET clinical trials results, the management of patients with bilateral LSCD is under optimization by reference to the pathogenesis of the underlying disease. Thus, autologous cultured oral mucosal epithelium transplantation seems promising for further studies and introduction into routine clinical practice. Key words: limbal stem cell deficiency, ocular surface reconstruction, corneal epithelium, oral mucosal epithelium, transplantation.

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.

Modified head inversion technique for pterygium and pseudopterygium surgery combined with keratopigmentation

2020 ◽  
pp. 112067212095830
Author(s):  
Rahul Kumar Bafna ◽  
Nidhi Kalra ◽  
Rajesh Sinha
Keyword(s):  
Stem Cell ◽  
Corneal Opacity ◽  
Limbal Stem Cell Deficiency ◽  
Modified Technique ◽  
Novel Technique ◽  
Inversion Technique ◽  
Visual Potential ◽  
Pterygium Surgery ◽  
Limbal Stem Cell

Purpose: We describe a single sitting modified technique of pterygium surgery along with corneal tattooing for combined cosmetic rehabilitation in eyes with corneal opacity and pterygium or pseudopterygium. Method: Five patients with corneal opacity due to healed keratitis/optically failed therapeutic grafts along with pterygium or pseudopterygium underwent combined pterygium surgery by head inversion technique and corneal tattooing in the same sitting. All patients had no visual prognosis in that eye and surgery was indicated for cosmetic reasons only. Results: At 6 months follow up no complications of pterygium surgery like recurrence, thinning, dellen, infections were noted in any patient. The dye was retained in the cornea and the cosmetic rehabilitation was excellent in all patients. Discussion: Corneal tattooing combined with pterygium/pseudopterygium surgery can be performed in a single sitting with this novel technique in eyes with no visual potential. This is particularly suitable for eyes with limbal stem cell deficiency or large pterygia/pseudopterygia where conjunctival autograft is not advisable. These patients are often apprehensive for an allograft from their only seeing other eye

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 Case series of cultivated oral mucosa epithelium transplantation for limbal stem cell failure

2018 ◽  
Vol 16 (2) ◽  
pp. 110-118
Author(s):  
Kah Lay Oh ◽  
Aida Zahidin ◽  
Umi Kalthum Md Noh ◽  
Safinaz Mohd Khialdin ◽  
Ghee Chien Ooi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Stem Cell ◽  
Oral Mucosa ◽  
Ocular Surface ◽  
Case Series ◽  
Limbal Stem Cell Deficiency ◽  
Corneal Transplant ◽  
Ocular Rosacea ◽  
Limbal Stem Cell ◽  
Mucosa Epithelium

Purpose: To report a case series of seven eyes (six patients) with severe limbal stem cell failure who underwent cultivated oral mucosa epithelium transplantation (COMET) in preparation for corneal transplant surgery and assess the change in visual acuity postoperatively. Design: Case series. Methods: A retrospective analysis of an interventional case series of six patients with severe limbal stem cell deficiency who underwent COMET between 2012 and 2015 was performed. Six eyes had COMET followed by corneal transplant, and one eye had corneal transplant preceding COMET. The change in the visual acuity after operation was evaluated. Results: A total of six patients with seven eyes were studied. All of them had severe ocular surface disease with limbal stem cell deficiency (LSCD) secondary to chemical injury (five eyes), SJS (one eye), and severe ocular rosacea (one eye). Four eyes had improvements in visual acuity, two of which achieved best corrected visual acuity (BCVA) of 6/12. Conclusion: The use of COMET helps to optimize the ocular surface in severe LSCD for further corneal transplant surgeries. It has helped to improve the graft uptake and subsequent visual improvement, especially in chronic chemical burn cases.  

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