Long-term results of allogeneic penetrating limbo-keratoplasty in total limbal stem cell deficiency*1

Reinhard, Thomas; Spelsberg, Helga; Henke, Lotte; Kontopoulos, Theodoros; Enczmann, Jürgen; Wernet, Peter; Berschick, Peter; Sundmacher, Rainer; Böhringer, Daniel

doi:10.1016/j.ophtha.2003.07.013

Cited by 114 publications

(80 citation statements)

References 37 publications

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“…Additionally, there was an improvement in visual acuity from 0.02 to 0.24 in patients with a clear graft and from 0.02 to 0.03 in cases of failure. The best visual acuity observed after long-term follow-up was 0.45 in patients with a clear graft and 0.26 in cases of failure (23) . Solomon et al evaluated 39 eyes that underwent CLAL with AM, with or without penetrating keratoplasty, and found that the overall survival of ambulatory vision (deemed as visual acuity greater than 0.1) was 53.6% at 3 years and 44.6% at 5 years (26) .…”

Section: Discussionmentioning

confidence: 85%

“…The definition of surgical success in studies on limbal stem cell deficiency varies in the literature, but it mostly includes reepithelialization and visual results, which respectively indicate anatomical and functional recovery of the ocular surface (22)(23)(24) . Shimazaki et al used the detection of donor tissue-derived epithelial cells in patients who underwent heterologous LSCT combined with penetrating keratoplasty, comparing with isolated cases of pe netrating keratoplasty as controls.…”

Section: Discussionmentioning

confidence: 99%

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Limbal transplantation at a tertiary hospital in Brazil: a retrospective study

Moreira

Magalhães

Pereira

et al. 2015

Arquivos Brasileiros De Oftalmologia

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Purpose: Epidemiological analysis of limbal transplantation surgeries performed in the Ophthalmologic Hospital of Sorocaba. Methods: Retrospective medical records review of 30 patients who underwent limbal stem cell transplants between January 2003 and March 2008. Cases involving conjunctival limbal autograft were classified as group I, and those involving conjunctival limbal allograft as group II. Results: Two patients were excluded due to incomplete data during postoperative follow-up. Of the total sample of 28 patients, 53.6% constituted group I, whereas 46.4% were included in group II. Males were predominant (67.9%), and right eyes were the most prevalent (67.9%). The mean age was 40.3 years. Unilateral cases accounted for 60.7%. The most frequent pathology causing limbal system failure was chemical burns (53%). The mean length of time from diagnosis to surgery was 11.18 years. The limbal graft and amniotic membrane were associated in 75% of all cases, and tarsorrhaphy in 57.1%. The average follow-up period was 24.84 months. The uncorrected visual acuity improved in 38% of the cases, was unchanged in 28.5%, and deteriorated in 33.3%. There was no persistent epithelial defect in 75% of the patients. The conjunctivalization rate was similar between the groups (53.3% and 58.3%, respectively). The transparency improved in only 38.4% of the cases, and 28.5% of the surgeries performed were successful. The most prevalent complication was persistent epithelial defect, which occurred in 25% of the patients, followed by corneal melting in 14.2%. Other complications observed included infectious ulcers, limbal graft necrosis or ischemia, perforation, and descemetocele. Conclusion: Chemical burns remain the main cause of limbal stem cell deficiency. In these cases, limbal transplantation is the standard procedure to restore the ocular surface even though the success rate is low. Keywords

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Limbal transplantation at a tertiary hospital in Brazil: a retrospective study

Moreira

Magalhães

Pereira

et al. 2015

Arquivos Brasileiros De Oftalmologia

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“…Anti-inflammatory drugs are not sufficient to suppress angiogenesis, conjunctivalization, and corneal scarring. LSC transplantation has a high risk of immune rejection [1,2] . Corneal transplantation remains the main and effective method for visual rehabilitation once a disease has affected corneal clarity [3] .…”

Section: Introductionmentioning

confidence: 99%

Mesenchymal stem cells: Potential role in corneal wound repair and transplantation

Li¹

2014

WJSC

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Corneal diseases are a major cause of blindness in the world. Although great progress has been achieved in the treatment of corneal diseases, wound healing after severe corneal damage and immunosuppressive therapy after corneal transplantation remain problematic. Mesenchymal stem cells (MSCs) derived from bone marrow or other adult tissues can differentiate into various types of mesenchymal lineages, such as osteocytes, adipocytes, and chondrocytes, both in vivo and in vitro . These cells can further differentiate into specific cell types under specific conditions. MSCs migrate to injury sites and promote wound healing by secreting anti-inflammatory and growth factors. In addition, MSCs interact with innate and acquired immune cells and modulate the immune response through their powerful paracrine function. Over the last decade, MSCs have drawn considerable attention because of their beneficial properties and promising therapeutic prospective. Furthermore, MSCs have been applied to various studies related to wound healing, autoimmune diseases, and organ transplantation. This review discusses the potential functions of MSCs in protecting corneal tissue and their possible mechanisms in corneal wound healing and corneal transplantation.

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“…Limbal autografts risk creating LSCD in the donor eye (6) and cannot be used in patients with bilateral LSCD. Limbal allografts require long-term systemic immunosuppression, and even with immunosuppression, rejection occurs in 42.9% to 64.0% of patients (7,8). One therapeutic strategy for corneal inflammation is the use of the adult stem/progenitor cells from bone marrow referred to as mesenchymal stem cells or multipotent mesenchymal stromal cells (MSCs).…”

mentioning

confidence: 99%

Anti-inflammatory protein TSG-6 reduces inflammatory damage to the cornea following chemical and mechanical injury

Roddy²,

Choi³

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

206

193

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Previous reports demonstrated that adult stem/progenitor cells from bone marrow (multipotent mesenchymal stem cells; MSCs) can repair injured tissues with little evidence of engraftment or differentiation. In exploring this phenomenon, our group has recently discovered that the therapeutic benefits of MSCs are in part explained by the cells being activated by signals from injured tissues to express an anti-inflammatory protein TNF-α-stimulated gene/protein 6 (TSG-6). Therefore, we elected to test the hypothesis that TSG-6 would have therapeutic effects in inflammatory but noninfectious diseases of the corneal surface. We produced a chemical and mechanical injury of the cornea in rats by brief application of 100% ethanol followed by mechanical debridement of corneal and limbal epithelium. Recombinant human TSG-6 or PBS solution was then injected into the anterior chamber of the eye. TSG-6 markedly decreased corneal opacity, neovascularization, and neutrophil infiltration. The levels of proinflammatory cytokines, chemokines, and matrix metalloproteinases were also decreased. The data indicated that TSG-6, a therapeutic protein produced by MSCs in response to injury signals, can protect the corneal surface from the excessive inflammatory response following injury.inflammation | TNF-α-stimulated protein 6 | mesenchymal stem cells | neutrophil | matrix metalloproteinase

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Long-term results of allogeneic penetrating limbo-keratoplasty in total limbal stem cell deficiency*1

Cited by 114 publications

References 37 publications

Limbal transplantation at a tertiary hospital in Brazil: a retrospective study

Limbal transplantation at a tertiary hospital in Brazil: a retrospective study

Mesenchymal stem cells: Potential role in corneal wound repair and transplantation

Anti-inflammatory protein TSG-6 reduces inflammatory damage to the cornea following chemical and mechanical injury

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