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J. R. Ricardo, Sr., S. L. Barros, M. C. Martins, R. M. Hazarbassanov, C. C. Farias, M. S. dos Santos, J. A. P. Gomes; Autologous Cultivated Conjunctival Transplantation Cultivated Ex Vivo for the Treatment of Ocular Surface Disorders. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2599.
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To investigate the safety and efficacy of autologous cultivated conjunctival transplantation for the treatment of different ocular surface disorders.
Five patients with ocular surface disorders were selected for the procedure: four cases of cytological proved of Total Limbal Stem Cells Deficiency (TLSCD) (2 secondary to chemical injury, 1 with symblepharon and 1 without symblepharon; 1 secondary to Stevens-Johnson syndrome without symblepharon; 1 secondary to multiple surgeries for pterygium with symblepharon and pterygium) and 1 case with pterygium and symblepharon secondary to multiple surgeries for pterygium. Conjunctival epithelial cells were harvested from the forniceal conjunctiva of respective patients two weeks before ex-vivo transplantation. Cultivation of conjunctival epithelial cells on human amniotic membrane (AM) was carried out with DMEM/F12. At the time of transplantation, the area of diseased conjunctiva and cornea was excised and cultured conjunctival epithelium AM composite was transplanted onto surgical defect. Patients were followed up with serial slip-lamp examinations, fluorescein staining, photographic documentation and impression cytology.
A confluent stratified conjunctival epithelial sheet was formed on the AM within 15 days. Transplanted grafts remained epithelialized after surgery. A successful outcome, defined as resolution of the disease, maintenance of conjunctival epithelization, maintenance of graft integrity, and absence of significant complications was obtained in 3 patients. Two patients had recurrence of the symblepharon but improvement of the ocular surface transparency. A good functional and cosmetic result was achieved in all eyes. The mean follow-up period was 11 months.
Transplantations of autologous cultivated conjunctival epithelial cells on DMEM/F12 were successfully performed in patients with TLSCD and pterygium. However, the same results maybe more limited in symblepharon. More cases with longer follow-up are needed to further define the indications and limitations of this new cell therapy approach to treat ocular surface diseases.
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