Abstract
Purpose:
It is difficult to prognosticate the outcome of stem cell based therapy for ocular surface disease because the risk factors predisposing to failure of surgery are not clearly known.To address this issue,this study aimed to identify the clinical Indicators associated with failure of autologous cultivated limbal epithelial transplantation for the treatment of Limbal Stem Cell Deficiency (LSCD).
Methods:
This retrospective study included 526 eyes of patients suffering from unilateral LSCD following ocular surface burns who underwent autologous ex-vivo cultivated limbal epithelial transplantation between 2001 and 2011. This procedure involved obtaining a one-clock hour wide limbal biopsy from the healthy fellow eye and cultivating the limbal epithelial cells on a de-epithelised human amniotic membrane graft for 10-14 days. A confluent epithelial sheet along with the amniotic membrane graft was then transplanted onto the affected eye after clearing away the pathologic tissue covering the cornea. Post-operatively success of transplantation was defined as a completely epithelized, avascular and clinically stable corneal surface. A multivariate analysis was performed using multiple logistic regression to analyze the strength of association between the pre-operative, intra-operative and post-operative clinical factors and recurrence of LSCD.
Results:
Of the 526 eyes, the ocular surface was successfully restored in 292 (55.5%) eyes at a mean follow-up of 1.4 years. Among all the pre-, intra- and post-operative clinical factors that were assessed: presence of symblepharon (OR=1.2, P< 0.001), previous ocular surgeries (OR= 1.3, P= 0.02), pediatric age group (OR=1.4, P= 0.04) and simultaneous keratoplasty (OR=3.2, P= 0.02) were found to be associated with greater chances of failure of autologous cultivated limbal epithelial transplantation.
Conclusions:
Patients with extensive symblepharon, patients previously having undergone multiple ocular reconstructive procedures, children and patients requiring keratoplasty along with autologous limbal transplantation are at higher risk of recurrence of LSCD and need to be counseled accordingly.
Keywords: 482 cornea: epithelium •
721 stem cells