May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Autologous and Allogenic Transplantation of Cultivated Corneal Epithelial Equivalents on Intact Amniotic Membrane for the Treatment of Severe Ocular Surface Disease.
Author Affiliations & Notes
  • D. Meller
    Ophthalmology, University of Essen, Essen, Germany
  • T. Fuchsluger
    Ophthalmology, University of Essen, Essen, Germany
  • H. Westekemper
    Ophthalmology, University of Essen, Essen, Germany
  • M. Pauklin
    Ophthalmology, University of Essen, Essen, Germany
  • K.-P. Steuhl
    Ophthalmology, University of Essen, Essen, Germany
  • Footnotes
    Commercial Relationships  D. Meller, None; T. Fuchsluger, None; H. Westekemper, None; M. Pauklin, None; K. Steuhl, None.
  • Footnotes
    Support  DFG ME 1623/3-1 and DOG
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 5716. doi:https://doi.org/
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      D. Meller, T. Fuchsluger, H. Westekemper, M. Pauklin, K.-P. Steuhl; Autologous and Allogenic Transplantation of Cultivated Corneal Epithelial Equivalents on Intact Amniotic Membrane for the Treatment of Severe Ocular Surface Disease.. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5716. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To evaluate the use of ex-vivo cultivated corneal epithelial equivalents on intact amniotic membrane for the treatment of severe ocular surface disease.

Methods: : We performed ex-vivo expansion of corneal / limbal epithelial cells from a small limbal biopsy (1x2mm) harvested from the fellow eye or from a healthy donor. Ex-vivo expansion was performed on intact AM. Two weeks later, following laminar keratectomy, the AM with the expanded corneal epithelial cells were placed on the corneal defect. A second AM was used as protective patch. In case of allogenic donor source all but one patient were treated with cyclosporin A as a systemic immunosuppression. Postoperative follow-up included slit-lamp examinations with fluorescein staining, as well as photographic documentation. Graft integrity and postoperative complications were evaluated.

Results: : Follow-up was 18 ± 12.1 months. Thirty five patients (mean age 46,4 ± 17,3 years) underwent autologous (n=24) or allogenic (n=14) ex-vivo expansion and transplantation of corneal epithelial cells, which were expanded on intact amniotic membrane (AM). Limbal stem cell deficiency (LSCD) resulted from following chemical burn (n=18), thermal burns (n=2), pterygium, numerous surgeries at the limbus (n=2), GvhD (n=1), pemphigoid (n=1), epidermolysis (n=1), ocular perforating trauma (n=1), MMC toxicity (n=1), and chlamydia infection (n=1). At the present state of the follow-up 83,3% of the autologous transplantations and 69% of the allogenic transplantations were graded as successful and showed an improvement of vision acuity by > or = 2 lines. These patients showed a clear, smooth, and stable corneal ocular surface without recurrence of LSCD. In the autologous group loss of graft integrity were noted in 4 cases, in the allogenic group graft failure was noted in 2 cases whereas graft rejection occurred in 2 cases.

Conclusions: : The method of ex-vivo expansion of autologous-serum derived cultivated corneal epithelial equivalents harvested from the fellow eye, cadaveric or living-related donors offers a feasible possibility to reconstruct the ocular surface in a variety of states causing uni- or bilateral limbal stem cell deficiency. Further long term follow-up is necessary to conclude on whether the repopulation of the limbal epithelial stem cells, which is clinically apparent, is also effective in order to prevent late recurrences of the disease.

Keywords: cornea: epithelium • cornea: clinical science • regeneration 
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