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DT Tan, LP K Ang, JT S Theng, C Gomezperalta, H Cajucom-Uy, RW Beuerman, RM Lavker; Transplantation Of Autologous Cultured Conjunctiva For Pterygium Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):121.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To evaluate a new clinical transplantation procedure for pterygium surgery in which an autologous, conjunctival tissue equivalent was developed using ex vivo conjunctival basal cell expansion, for conjunctival replacement following pterygium excision. Methods:In 10 eyes of 10 patients with primary pterygium, conjunctival forniceal stem cell biopsies (1x3 mm) were obtained 2 weeks prior to pterygium excision. Conjunctival explants were cultivated on human amniotic membranes (AM) in serum-free conditions for a mean of 15 days. At the time of pterygium surgery, pterygia were excised, and autologous cultured conjunctival tissue equivalents were transplanted onto the excised pterygium bed. In 7 eyes, an additional amniotic membrane (AM) patch was sutured over the conjunctival tissue equivalent and removed after 3 days. Three eyes did not receive AM patches. Postoperative evaluation included serial slit-lamp photography with and without fluorescein staining. Results:In the 7 eyes with AM patch, excellent results were obtained: in 4 eyes, the cultured conjunctival constructs were 100% epithelised upon AM patch removal at day 3; in the other 3 eyes, transient, small, epithelial gaps (0.5mm2) were noted upon AM patch removal. All 7 eyes remained fully epithelised at day 7 onwards. In the 3 eyes without AM patch, larger epithelial gaps were noted in the initial postoperative period, with 10% epithelial gaps by day 7; however, full epithelization was noted at day 14. In all eyes, minimal ocular surface inflammation was noted, and patients were asymptomatic within a week. Currently at a mean follow-up of one month, observation for pterygium recurrence is ongoing. Conclusion:Autologous culture of conjunctiva by ex vivo conjunctival basal cell expansion results in a viable conjunctival tissue equivalent which can be successfully retransplanted at the time of pterygium excision, and the use of an AM patch assists in construct integrity in the early postoperative period. This procedure may obviate the need to harvest a large, superior bulbar conjunctival graft in conventional conjunctival autografting for pterygium, and may also be useful in other forms of ocular surface transplantation and reconstruction, and in many surgical procedures requiring healthy conjunctiva.
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