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J. Shimazaki, K. Higa, Y. Satake; Transplantation of Cultivated Epithelial Sheets Prepared by Fibrin-Coated Dishes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6175.
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We have reported biological properties of cultivated epithelial sheets that do not contain underlying substrates by using fibrin-coated dishes (Higa K, et al, IOVS 2007). We found that the sheets were more transparent and cultivated epithelium showed different biological characteristics compared with those prepared on amniotic membranes. The aim of the study is to investigate clinical results of patients undergone cultivated epithelial transplantation using the substrate-free epithelial sheets.
Either limbal (n=4) or autologous oral mucosal (n=5) epithelial cells were isolated and seeded onto fibrin-coated wells with SHEM containing aprotinin and cocultured with MMC-treated 3T3 fibroblasts. The cultures were submerged in medium until confluence, cultured in air-liquid interface for 1 week, and then incubated without aprotinin for 4 days. Following excision of cicatricial tissues, the sheets were transplanted on the ocular surface of 9 patients (5 males and 4 female, with a mean age of 55.8 years) that had severe cicatricial keratoconjunctivitis. Original diseases included Stevens-Johnson syndrome (n=2), chemical burn (n=3), ocular cicatricial pemphigoid (OCP, n=1), and pseudo-OCP (n=3).
At the time of surgery, all epithelial sheets were intact without significant fluorescein staining. The sheets adhered to the cornea and sclera without sutures. With a mean follow-up period of 14.1 months, 6 out of 9 eyes achieved stable ocular surface with the transplanted sheets maintained their clarity. Four of the 6 eyes achieved visual acuity ≥ 20/60. Three other eyes developed persistent epithelial defects within 1 month following surgery, resulting in either fibrovascular tissue invasion (2 eyes) or stromal melting (1 eye). We noticed significant reduction of corneal neovascularization in these eyes, with semi-quantitative scores improved from 2.9 to1.0.
Transplantation of cultivated epithelial sheets prepared by using fibrin-coated dishes seemed to be encouraging for the treatment of cicatricial keratoconjunctivitis.
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