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T. A. Fuchsluger, H. Westekemper, K.-P. Steuhl, D. Meller; Allogenic Bioengineered Limbal Stem Cells Highly Effectual in Ocular Surface Reconstructions in Limbal Stem Cell Deficiencies Due to Congenital Aniridias. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5742.
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© ARVO (1962-2015); The Authors (2016-present)
The main patient collective considered for tissue engineered limbal epithelial cells transplantations currently are chemical burn patients. This contribution puts the focus on special indications for the application of limbal stem cell deficiencies. We deliver insight into experiences and outcomes providing bioengineered limbal stem cells for deficiencies related to congenital aniridia keratopathy.
Six eyes suffering from congenital aniridia keratopathy and limbal stem cell deficiency were recruited. Epithelial stem cells harvested from a multi-organ donor were expanded on intact human amniotoc membrane (hAM) utilizing autologous serum (AS). After conjunctival peritomy, laminar keratectomy the AM with the expanded limbal epithelial stem cells was transferred to the conjunctival and corneal surface along with a protective superficial AM patch. Postoperatively, patients received Botox-induced ptosis within one week and were treated with AS eye drops. Allograft recipients received Ciclosporin A for immunosuppression. The main outcome measures were cultivation time, recurrence, post-operative bleeding, incidence of complications, motility restriction, persistent epithelial closure and establishment of lasting ocular surface integrity.
Follow-up was 12,0 ± 6,6 months (range 4-20). Six eyes (mean patient age 40,3 ± 5,5 years, range 35-46) underwent transplantation of limbal epithelial stem cells expanded on intact hAM. All but one eye (83,3%) improved reaching functional ambulatory visual acuity (< 20/200) benefitting from reduced glare sensitivity. All eyes but one showed a clear, smooth, and stable corneal ocular surface without signs of recurrence as neovasularization. Post-surgical complications were little postoperative bleeding and slight peripheric corneal scarring.
Bioengineered corneal epithelium cultivated on hAM offers a promising possibility to reconstruct the ocular surface in eyes affected by various demanding conjunctival and corneal entities. 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 diseases.
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