Successful Transplantation of Bioengineered Tissue Replacements in Patients with Ocular Surface Disease

Abstract

This novel technique documents that presumed corneal epithelial stem cells can be harvested safely from the limbus, expanded successfully in vitro, and grown on denuded amniotic membrane. The resultant composite cultured tissue can be transplanted and appears to successfully manage eyes with difficult ocular surface disease, including those with stem cell deficiency. This technique minimizes the threat of damage or depletion to the contralateral or donor limbus.

Factors Influencing Outcomes in Cultivated Limbal Epithelial Transplantation for Chronic Cicatricial Ocular Surface Disorders

“…The results were similar to those reported in keratolimbal allograft transplantation (KLAL). 15,27,28 The rate of success seemed to be worse than the previous reports 1, 3,5,12 , and the difference was probably attributed to the differences in patient selection and preoperative condition.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][17][18][19][20][21][22][23][24][25][26] Although short-term outcomes appeared promising, only a few mid-term or long-term results have been reported. Validity of CLET for acute phase of chemical burns and SJS was reported, 6 however, the efficacy of the method for chronic cicatricial keratoconjunctivitis seems to be less dramatic.…”

“…The method was first reported by Pellegrini et al in 1997, followed by several other investigators including our group. [1][2][3][4][5][6][7][8][9][10][11][12] In our previous report in 2002, the short-term outcomes of CLET were comparable with conventional limbal epithelial transplantation. 7 We found that the method did not produce excellent outcomes in patients with severe cicatricial ocular surface disorders such as Stevens-Johnson syndrome (SJS) and chemical/thermal burns of the cornea.…”

Surgical rehabilitation following severe ocular burns

“…40,[47][48][49][50] Unfortunately, a definitive assessment of the number of stem cells in any culture is presently impossible because there is no definitive marker of limbal epithelial stem cells. 51 The long-term fate of these transplanted stem cells is also unclear.…”

Cultivo primário de células epiteliais germinativas do limbo de olhos doadores

“…Vários autores já demonstraram que suficientes células germinativas podem ser obtidas de biópsia do limbo de aproximadamente 2mm² (4)(5)(6)(7)(8)(9)(10)(11)(12)(13) e após expandidas in vitro, serem transplantadas para o olho acometido, em alguns casos tendo como substrato a membrana amniótica humana. Esta técnica parece ser muito promissora, já que elimina o problema de tecido doador insuficiente, rejeição de transplantes homógenos e exaustão de células germinativas do olho doador.…”