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