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Jun Shimazaki, Kazunari Higa, Yoshiyuki Satake; Long-term Outcomes of Cultivated Epithelial Sheet Transplantation for Chemical or Thermal Burns of the Cornea. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2278.
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Although short-term outcomes of the cultivated epithelial sheet transplantation (CEST) seemed to be promising, the long-term results have not been fully understood. The present study was conducted to elucidate the long-term outcomes of the surgery, and to clarify the risk factors for the postoperative failure.
We retrospectively analyzed consecutive cases that had CEST in our hospital from 2003 to 2014 and followed-up for more than 1 year following surgery. They included 44 eyes of 40 cases (33 men and 7 women, with a mean age of 45.3 ± 18.6 years). The most common cause of injury was alkali burn (25 eyes). A total of 60 surgeries were performed using donor tissues of either autologous or allogeneic limbal epithelial cells (n=12 each), living-related limbal epithelial cells (n=3), or autologous oral mucosal epithelial cells (n=33). They were cultivated on either human amniotic membrane (n=43) or fibrin (n=17) for approximately 2 weeks, and transplanted on the corneal surface following removal of scar tissues. Ocular surface conditions were semi-quantitatively assessed by slit lamp photographs using a grading system (Sotozono C, et al., Ophthalmology 2007). Main outcomes included successful ocular surface reconstruction (no epithelial defects without conjunctivalization to the central cornea), clear cornea, and corrected visual acuity (CVA) > 20/200.
Successful ocular surface reconstruction was achieved in 61%, 43%, 32%, and 51% at 1, 3, 5 years and the final follow-up following CEST, respectively. The incidence of clear grafts was 45%, 40%, 52%, and 49%, and that of CVA > 20/200 was 41%, 52%, 33%, and 38% at 1, 3, 5 years and the final follow-up, respectively. No significant associations were noted between the postoperative outcomes and neither causes of injury or source of donor cells.
Approximately half of the eyes achieved long-term success following CEST for chemical/thermal burns of the cornea. Proper selection for surgical intervention, timing of surgery, and intensive postoperative managements seemed to be all important for the long-term success.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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