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Meeta Pathak, Liv K. Drolsum, Kristiane Haug, Aboulghassem Shahdadfar, Morten C. Moe, Bjorn Nicolaissen; Transplantation Of Ex Vivo Expanded Autologous Limbal Stem Cells Cultured In A Medium Free Of Animal-derived Products - A Presentation Of Four Cases. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5137.
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Patients with limbal stem cell deficiency (LSCD) experience pain, reduced vision, photophobia and foreign body sensation. These patients can be treated with transplantation of ex vivo expanded limbal epithelial stem cells (LESC). Several culture media containing animal-derived products, e.g. fetal calf serum (FCS), and growth factors have been used for this purpose.We examined the outcome of four patients treated with transplantation of autologous ex vivo LESCs explanted on amniotic membrane (AM) cultured in medium containing autologous serum, a medium free of animal-derived products and human recombinant growth factors.
Inclusion criteria were a history and clinical signs of unilateral or bilateral LSCD. Limbal biopsies were obtained from the patients and limbal stem cells were cultured on AM for 2 weeks, after which the AM with cultured LESCs was transplanted to the patient. Postoperatively, the patients were treated with topical steroid and antibiotic and followed up with clinical examination and photographs.
The study included 4 eyes from 4 patients. 2 eyes had LSCD following thermal injury, 2 due to chemical injury. The patients consisted of 3 men, aged 21, 63, 65 and 1 woman, aged 68. Mean follow-up was 14.5 months (range 10-17 months). Successful outcome was defined as subjective relief of pain and photophobia with equal or improved best corrected visual acuity and re-establishment of a stable transparent corneal epithelium and regression of corneal vascularisation, based on slit-lamp examination and photographs. In all patients, re-epithelialisation occurred within one week. Inflammation and vascularisation were reduced within one month. 2 patients had unaltered visual acuity, whereas 2 experienced an improvement. 2 patients had experienced pain and photophobia prior to treatment, and both reported relief of pain postoperatively. However, one patient started experiencing irritation again after 6 months.
In our study, we found a successful outcome in 3 of the 4 patients treated. The results are promising and more patients will be included in further studies.
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