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J. Kim, G. Song, Y. Chun, J. Kim; In vivo Grown Corneal Epithelium Transplantation on the Severly Damaged Cornea. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1871.
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© ARVO (1962-2015); The Authors (2016-present)
To report our experience of the treatment using transplantation of in vivo grown corneal epithelium with stem cell niche in 4 patients with severe ocular surface disease.
Four patients with ocular surface disease unresponsive to standard medical and surgical treatments were chosen for transplantation. They underwent transplantation of in vivo grown epithelial sheet in the worse eye.The living related donor underwent epithelial peeling, followed by denuded amniotic membrane transplantation(AMT) in the nondominant eye and the corneal stem cell were expanded in vivo. After epithelialization was completed, epithelium on the amniotic membrane with stromal cell was harvested gently, which was transplanted to patient eye after debriment of fibrovascular tissue. The epithelial sheet was evaluated by morphology with light microscope and transmission electron microscope, and also examined by immunohistochemical staining.
The cultivated epithelium was completely epithelialized in 2 weeks and well differentiated, showing well-formed hemidesmosome. On immunohistochemical staining, Connexin 43, Integrin ß4, and CD34 were strongly expressed in the epithelial sheet. Persistent epithelial defect was covered completely, and maintained clearly for 4 weeks in all cases. But corneal erosion and conjunctivalization recurred after 5 weeks in 2 cases.
This novel technique documents that corneal epithelial stem cells can be expanded in vivo successfully on the denuded AM of the healthy cornea and harvested safely. In vivo grown corneal epithelial sheet with stem cell niche can be transplanted and appears to successfully manage the eye with severly damaged ocular surface disease, such as total limbal deficiency.
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