Cultivated Limbal Epithelial Transplantation in Children With Ocular Surface Burns

Sejpal, Kunjal; Ali, Mohammed; Maddileti, Savitri; Basu, Sayan; Ramappa, Muralidhar; Kekunnaya, Ramesh; Vemuganti, Geeta K.; Sangwan, Veena

doi:10.1001/jamaophthalmol.2013.2308

Cited by 92 publications

(81 citation statements)

References 23 publications

(31 reference statements)

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“…As for the condition of donor eyes, which was mentioned in 4 studies, 25,28,30,32 no complications were reported. Following CLET, in 7 studies 25,28,31,34,37,38,41 it was reported that 18 eyes were suffering from microbial keratitis, but through fortified topical antibiotics or emergency keratoplasty 11 eyes were fully cured.…”

Section: Complications and Adverse Eventsmentioning

confidence: 99%

“…Eighteen articles [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] reported a success rate (Table 4) with 381 successful procedures in a total of 572 eyes. The pooled success rate was 67% (95% CI, 0.59-0.75; I 2 = 60%, P = 0.0006; Fig.…”

Section: Improvement In Ocular Surfacementioning

confidence: 99%

“…Following CLET, in 7 studies 25,28,31,34,37,38,41 it was reported that 18 eyes were suffering from microbial keratitis, but through fortified topical antibiotics or emergency keratoplasty 11 eyes were fully cured. Furthermore, perforation or corneal thinning requiring tissue adhesive application occurred in 14 eyes, 25,28,33,35,38 whereas 58 eyes had hemorrhage under the AM, 25,28,35 but this diminished spontaneously. Other complications were epithelial rejection, endothelial rejection, corneal allograft rejection, granuloma, and panophthalmitis.…”

Section: Complications and Adverse Eventsmentioning

confidence: 99%

“…may be used as a cell substrate in the ex vivo culture. But human amniotic membrane (HAM), which promotes epithelialization, inhibits fibrosis, has anti-inflammatory and antiangiogenic properties, and possesses antimicrobial and antiviral properties and a high hydraulic conductivity, 22,23 with low or no immunogenicity, 24 has become the widely used material [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] acting as a surrogate environmental stem cell niche. 43 The use of ex vivo cultured LESCs to treat corneal LSCD in humans was first described by Pellegrini et al 44 in 1997. Subsequently, plenty of case series and reviews have reported the efficiency and evidence of this treatment.…”

mentioning

confidence: 99%

“…43 The use of ex vivo cultured LESCs to treat corneal LSCD in humans was first described by Pellegrini et al 44 in 1997. Subsequently, plenty of case series and reviews have reported the efficiency and evidence of this treatment. 12,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][45][46][47] However, with the lack of sufficient cases or valid measurements, they failed to provide a convincing assessment of this surgery. Moreover, there is controversy regarding the clinical outcome between different sources of limbal stem cells, such as autograft and allograft.…”

mentioning

confidence: 99%

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Systematic Review and Meta-analysis on Transplantation of Ex Vivo Cultivated Limbal Epithelial Stem Cell on Amniotic Membrane in Limbal Stem Cell Deficiency

Zhao

2015

Cornea

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CLET is efficacious in patients with LSCD, and no difference both in success rate and visual acuity outcome between autograft and allograft was found. Overall safety profile was good, with most side effects being transient and amenable to subsequent treatments. The long-term results of autograft and allograft will inform future treatment algorithms and techniques with random control trials and better-designed analysis.

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Section: Complications and Adverse Eventsmentioning

confidence: 99%

Section: Improvement In Ocular Surfacementioning

confidence: 99%

Section: Complications and Adverse Eventsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Systematic Review and Meta-analysis on Transplantation of Ex Vivo Cultivated Limbal Epithelial Stem Cell on Amniotic Membrane in Limbal Stem Cell Deficiency

Zhao

2015

Cornea

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Long-Term Results of Cultured Limbal Stem Cell Versus Limbal Tissue Transplantation in Stage III Limbal Deficiency

Borderie

Ghoubay

Georgeon

et al. 2019

Stem Cells Translational Medicine

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We aimed to evaluate efficiency and safety of transplantation of limbal stem cells (LSC) cultured on human amniotic membrane with no feeders and to compare cultured LSC with limbal tissue transplantation. Thirty eyes with stage III LSC deficiency were treated with autologous (autoLSC) or allogeneic (alloLSC) cultured LSC transplantation (prospective phase II clinical trial; average follow-up time, 72 months) or autologous (autoLT) or allogeneic (alloLT) limbal tissue transplantation (retrospective control group; average follow-up time, 132 months) between 1993 and 2014. The 5-year graft survival defined by absence of recurrence of the clinical signs of limbal deficiency was 71% for autoLSC, 0% for alloLSC, 75% for autoLT, and 33% for alloLT. Visual acuity improved by 9.2 lines for autoLSC and 3.3 lines for autoLT. It decreased by 0.7 lines for alloLSC and 1.9 lines for alloLT. Adverse events were recorded in 1/7 autoLSC, 7/7 alloLSC, 6/8 autoLT, and 8/8 alloLT patients. Corneal epithelial defect was the only adverse event recorded after autoLSC, whereas severe sight-threatening adverse events were recorded in the remaining three groups. Compared with failed grafts, successful grafts featured greater decrease in fluorescein staining, greater superficial vascularization-free corneal area, lower variability of the corneal epithelial thickness, and higher corneal epithelial basal cell density. Autologous cultured LSC transplantation was associated with high long-term survival and dramatic improvement in vision and was very safe. Autologous limbal tissue transplantation resulted in similar efficiency but was less safe. Cadaver allogeneic grafts resulted in low long-term success rate and high prevalence of serious adverse events. STEM CELLS TRANSLATIONAL MEDICINE 2019;8:1230-1241 LESSONS LEARNED• Transplantation of autologous cultured limbal stem cells was associated with high long-term survival, dramatic improvement in vision, and high safety. • Transplantation of autologous limbal tissue resulted in similar efficiency but lower safety.• Cadaver allogeneic grafts resulted in low long-term success rate and high prevalence of serious adverse events. SIGNIFICANCE STATEMENTAutologous cultured limbal stem cell transplantation was associated with high long-term survival, vision improvement, and safety, whereas limbal grafts featured lower safety and allogeneic grafts featured low success rate and serious adverse events.

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Simple limbal epithelial transplantation: Current status and future perspectives

Jackson

Ernø

Ringstad

et al. 2019

Stem Cells Translational Medicine

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Damage to limbal stem cells as a result of injury or disease can lead to limbal stem cell deficiency (LSCD). This disease is characterized by decreased vision that is often painful and may progress to blindness. Clinical features include inflammation, neovascularization, and persistent cornea epithelial defects. Successful strategies for treatment involve transplantation of grafts harvested from the limbus of the alternate healthy eye, called conjunctival‐limbal autograft (CLAU) and transplantation of limbal cell sheets cultured from limbal biopsies, termed cultured limbal epithelial transplantation (CLET). In 2012, Sangwan and colleagues presented simple limbal epithelial transplantation (SLET), a novel transplantation technique that combines the benefits of CLAU and CLET and avoids the challenges associated with both. In SLET a small biopsy from the limbus of the healthy eye is divided and distributed over human amniotic membrane, which is placed on the affected cornea. Outgrowth occurs from each small explant and a complete corneal epithelium is typically formed within 2 weeks. Advantages of SLET include reduced risk of iatrogenic LSCD occurring in the healthy cornea at harvest; direct transfer circumventing the need for cell culture; and the opportunity to perform biopsy harvest and transplantation in one operation. Success so far using SLET is comparable with CLAU and CLET. Of note, 336 of 404 (83%) operations using SLET resulted in restoration of the corneal epithelium, whereas visual acuity improved in 258 of the 373 (69%) reported cases. This review summarizes the results of 31 studies published on SLET since 2012. Progress, advantages, challenges, and suggestions for future studies are presented.

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Cultivated Limbal Epithelial Transplantation in Children With Ocular Surface Burns

Cited by 92 publications

References 23 publications

Systematic Review and Meta-analysis on Transplantation of Ex Vivo Cultivated Limbal Epithelial Stem Cell on Amniotic Membrane in Limbal Stem Cell Deficiency

Systematic Review and Meta-analysis on Transplantation of Ex Vivo Cultivated Limbal Epithelial Stem Cell on Amniotic Membrane in Limbal Stem Cell Deficiency

Long-Term Results of Cultured Limbal Stem Cell Versus Limbal Tissue Transplantation in Stage III Limbal Deficiency

Simple limbal epithelial transplantation: Current status and future perspectives

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