Surgical Management of Bilateral Limbal Stem Cell Deficiency

Vazirani, Jayesh; Mariappan, Indumathi; Ramamurthy, Shreyas; Fatima, Saba; Basu, Sayan; Sangwan, Veena

doi:10.1016/j.jtos.2016.02.006

Cited by 44 publications

(34 citation statements)

References 101 publications

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“…Serious postoperative complications following keratoprosthesis implantation occur much more often than in other optical corneal procedures 19. However, surgical management of complications is extremely challenging in eyes with a Boston type II keratoprosthesis and particularly in eyes implanted with MOOKP, due to the altered ocular anatomy.…”

Section: Discussionmentioning

confidence: 99%

LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness

et al. 2018

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Section: Discussionmentioning

confidence: 99%

LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness

et al. 2018

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“…Keratoplasties were not successful in such cases, and stem cell transplantation seems to be a viable option for ocular surface rehabilitation in such cases. [2910]…”

Section: Discussionmentioning

confidence: 99%

“…[1] Limbal stem cell deficiency (LSCD) is an important consequence of the ocular chemical injuries which can have varied manifestations such as loss of palisades of Vogt, localized vascularization or conjunctivalization in mild grade chemical injuries to severe conjunctivalization, keratinization, symblepharon formation, and subsequent loss of vision in severe chemical injuries. [234] Cosmetic and visual rehabilitation in such patients is quite a challenging task considering the associated morbidity of the ocular surface and loss of limbal stem cells which threatens the survival of the corneal graft. These limbal cells are essential for the epithelialization of the cornea.…”

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confidence: 99%

“…Therefore, ocular surface rehabilitation forms the stepping stone in such cases before any further procedures can be performed. [25] Various modalities of limbal stem cell transplantation (LSCT) to replenish the limbal stem cells have been tested over the years, and the decision for undertaking any particular procedure solely depends on the severity of LSCD and the laterality of the condition. [678910] Cultivated limbal epithelial transplant (CLET) has shown good results in both unilateral and bilateral ocular chemical injuries.…”

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confidence: 99%

“…[812131415] This technique co-opts the advantages of combining conjunctival limbal autograft and cultivated limbal stem cell transplant and obviates the need for ex vivo expansion of cells and expensive laboratory setup. [289] Once ocular surface stabilization is achieved with SLET reconstruction, visual rehabilitation can be undertaken as either lamellar or full-thickness keratoplasty. The inflammatory response to any kind of injury is expected to be more in the pediatric age group.…”

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Outcomes of deep anterior lamellar keratoplasty following autologous simple limbal epithelial transplant in pediatric unilateral severe chemical injury

Singh

Vanathi

Gupta

et al. 2017

Indian J Ophthalmol

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Aims:To evaluate outcomes of deep anterior lamellar keratoplasty (DALK) in pediatric eyes with unilateral severe chemical injury which have undergone autologous simple limbal epithelial transplant (SLET).Settings and Design:The study design was a retrospective case series.Materials and Methods:This retrospective, case series of all children <16 years of age that have undergone DALK following autologous SLET procedure in unilateral severe chemical injury evaluates the outcomes and complications in the setting of a tertiary care center in North India.Statistical Analysis Used:Nonparametric data have been expressed as median (range), parametric qualitative data as percentage, and quantitative data as a mean ± standard deviation. Spearman's correlation coefficient is used for finding a correlation between variables.Results:Eleven eyes of 11 children (5 male and 6 female) with a mean age of 8.9 ± 4.7 years underwent DALK following ocular surface reconstruction with autologous SLET earlier for unilateral severe chemical injury with limbal stem cell deficiency. Follow-up ranged from 6 to 18 months (13.00 ± 4.58 months) following DALK procedure. All patients with a minimal follow-up of 6 months were evaluated for visual outcomes. Visual acuity ranged from 0.3 to 3 logMAR units (0.6 ± 0.2 logMAR units). Complications were encountered in three patients. Anatomical success was seen in 72.72% patients and visual success was noted in 54.54% patients.Conclusions:DALK is a feasible option in children with severe unilateral chemical injury who have undergone ocular surface reconstruction with autologous SLET procedures.

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Transplantation of human corneal limbal epithelial cell sheet harvested on synthesized carboxymethyl cellulose and dopamine in a limbal stem cell deficiency

Lee

Hong

et al. 2020

J Tissue Eng Regen Med

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This study aimed to evaluate the efficacy and safety of transplantation with human corneal limbal epithelial (HCLE) cell sheets cultured on carboxymethyl cellulose (CMC)–dopamine (DA)‐coated substrates and harvested via enzymatic digestion of CMC with cellulase in a rabbit animal model of limbal stem cell deficiency (LSCD). Synthesized CMC–DA was pretreated onto the surface of culture plates. Then, HCLE cells were cultured on precoated CMC–DA and HCLE cell sheets were harvested using cellulase‐containing cell culture medium. HCLE cell sheets were evaluated using a live/dead assay, histological examination, and immunofluorescence staining. For in vivo assessment, HCLE cell sheets were transplanted in a rabbit model of LSCD for 2 weeks to determine the effectiveness of the repair. Primary culture of HCLE cells stained positively for p63, cytokeratin (CK)15, and CK12. HCLE cell sheets were generated with a well‐preserved morphology and transparency ranging in size from 15 to 19 mm after cellulase‐assisted cell sheet generation. HCLE cell sheets uniformly stained positively for human mitochondria, p63, CK15, CK12, CK3/2p, and zonula occludens (ZO)‐1. HCLE cell sheet transplantation in a rabbit model of LSCD improved the corneal opacity and neovascularization scores. Transplanted HCLE cell sheets stained positively for p63 and CK12. Transplantation of HCLE cell sheets harvested on CMC–DA coating combined with cellulase is a safe and efficient procedure for corneal epithelial regeneration in a rabbit model of LSCD. This system could enable a promising strategy to regenerate corneal epithelium by transplantation in ocular surface disorders.

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Surgical Management of Bilateral Limbal Stem Cell Deficiency

Cited by 44 publications

References 101 publications

LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness

LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness

Outcomes of deep anterior lamellar keratoplasty following autologous simple limbal epithelial transplant in pediatric unilateral severe chemical injury

Transplantation of human corneal limbal epithelial cell sheet harvested on synthesized carboxymethyl cellulose and dopamine in a limbal stem cell deficiency

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