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J. Li, H. Cajucom-Uy, C. Gomezperalta, J. Theng, L. Ang, D. Tan; Clinical Trial on the Use of Autologous Cultured Conjunctival Epithelium for Pterygium Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1363.
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Purpose: To evaluate ex-vivo cultured autologous conjunctival tissue equivalent as a conjunctival replacement following pterygium excision Methods: Superior forniceal conjunctival biopsies (1mm x 3 mm) were obtained from patients 2 weeks prior to pterygium surgery. Biopsies were cultured on human amniotic membrane (HAM) in KGM without serum. Cells reached confluence by day 10-12, and subsequent proliferation, stratification and differentiation occurred. At day 14, pterygium surgery was performed – after excision of the pterygium, the autologous multi-layered conjunctival equivalent was sutured over the excised pterygium bed with 10-0 vicryl sutures, and an additional amniotic membrane graft was applied on top as a protective patch. The latter was removed 4 days post-op and patients were followed up at regular intervals up to 12 months. Results: 23 primary pterygium excisions were performed in 22 eyes. In all cases, the transplantation of autologous conjunctival equivalents was successful, with intact cultured epithelium noted over the graft bed upon the removal of the amniotic membrane patch. Ocular surface inflammation and other complications were minimal. However, at the mean follow-up of 9 months (range of 6 months to 1 year), pterygium recurrence occurred in 8 eyes (34.7%). Conclusions: The development of a conjunctival tissue equivalent by ex-vivo expansion of autologous human conjunctival epithelial cells on HAM results in a tissue equivalent which can be transplanted. Pterygium recurrence rates with this tissue equivalent appears to be lower than simple bare sclera excision, but higher as compared to that of pterygium excision with conjunctival autografting, and are similar to conventional amniotic membrane transplantation, with the added advantage that no epithelial defect exists immediately following surgery.
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