Abstract
Purpose: :
The long-term outcomes of autologous cultured limbal epithelial transplantation (CLET) as a treatment for alkali induced limbal epithelial stem cell (LESC) deficiency are encouraging. The effectiveness of allogeneic CLET for alkali injury or LESC deficiency caused by other conditions remains unclear. This study investigated the outcomes of allogeneic CLET for aniridia and Stevens-Johnson syndrome (SJS) related LESC deficiency.
Methods: :
Fourteen eyes of 13 patients with profound LESC deficiency arising from aniridia (n=10) and SJS (n=4) were treated with superficial keratectomy, allogenic CLET and systemic immunosuppression. Clinical photographs, visual acuity, impression cytology and confocal microscopy were performed. Clinical parameters of LESC deficiency (loss of epithelial transparency, superficial corneal vascularization, epithelial irregularity and epithelial breakdown) were graded from clinical photographs by two masked observers. Images were compared against a set of standardised grading plates. Scores for each parameter were totalled to give a grading score reflective of the degree of stem cell deficiency. An unsuccessful outcome was defined as a post-operative score of more than 4.
Results: :
Follow-up data was available through 24 months in 100% of patients, 36 months in 86% and in 48 months in 36%. Overall, post-operative visual acuity was better than pre-operative in 71% of patients at 12 months (n=14), 60% at 24 months (n=14), 67% at 36 months (n=12) and 75% at 48 months (n=4). Grading of clinical photographs showed a stable ocular surface and healthy corneal epithelium in 43% of patients at 12 months, 31% at 24 months and 36% at 36 months but no patients at 48 months. Outcomes for aniridia were superior to those for SJS.
Conclusions: :
Allogeneic CLET improves visual acuity in patients with aniridia and SJS related LESC deficiency but clinical signs recur in the majority of patients by 3 to 4 years post treatment. Outcomes for aniridia are superior to SJS.
Keywords: cornea: epithelium • cornea: clinical science