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Oliver Baylis, Hardeep Mudhar, Majlinda Lako, Francisco Figueiredo; Outcomes of Penetrating Keratoplasty after ex vivo Expanded Autologous Limbal Stem Cell Transplantation in Humans. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1005.
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© ARVO (1962-2015); The Authors (2016-present)
To study the clinical and histological outcomes of patients who received ex vivo expanded autologous limbal stem cells (LSC) on human amniotic membrane (AM) followed by penetrating keratoplasty (PK) for the treatment of unilateral total limbal stem cell deficiency (LSCD).
Prospective, single-centre, noncomparative, interventional case series. Participants: 5 consecutive patients with unilateral LSCD were treated at the Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK between April 2006 and November 2012. Intervention: HLA-matched PK was performed at least 6 months after ex vivo expanded autologous LSC using an animal and feeder free method combined with high dose topical steroid. Outcome measures: LSC survival was assessed by slit lamp biomicroscopy, histology of excised corneal buttons and post-PK corneal impression cytology (IC) showing absence of goblet cells. PK survival, best corrected visual acuity (BCVA), patient-reported outcomes and complications were also recorded.
All patients were male with a mean age of 52 (range 20-77). Six PK were performed in 5 eyes of 5 patients, with 1 regraft. Mean LSC and PK follow up was 63 months (range 35-78) and 28 months (range 4-48) respectively. Postoperatively, satisfactory ocular surface reconstruction was maintained in all eyes (100%), as confirmed by IC. One patient was lost to follow-up 4 months after PK. At last examination, BCVA improved in 4 eyes (≥6/36). Vision impairment and pain scores improved in all patients (p<0.05). Complications: PK rejection with subsequent failure occurred twice in 1 eye. Histology of excised corneas after PK showed complete absence of goblet cells, 100% CK3 +ve corneal epithelial cells and presence of p63 +ve LSC-like cells in the basal epithelium in all corneas. In addition, TEM revealed a uniform stratified epithelium, typical of the normal central cornea.
This study demonstrates that transplantation of ex vivo expanded autologous LSC cultured on AM followed by PK is an effective method of reconstructing the corneal surface and restoring useful vision in patients with unilateral total LSCD. Despite HLA-matching PK and high dose topical steroid, graft rejection with failure may still occur in this high risk group of patients. Further studies with more patients and longer follow-up should be conducted.
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