title: Ocular surface restoration using non-surgical transplantation of tissue-cultured human amniotic epithelial cells.
abstract: OBJECTIVE
  To assess the effect of tissue-cultured human amniotic epithelial cells (AECs) in restoring the ocular surface, transplanted using a collagen shield seeded with AECs supported by a soft contact lens.
  
  
  METHODS
  Prospective interventional single-institutional case series with crossover controls.
  
  
  METHODS
  Three eyes in three patients were identified with persistent corneal epithelial defects (PEDs) refractory to medical therapy. Two cases were secondary to neurotrophic keratopathy, while one case was attributable to longstanding alkali injury. AECs were isolated from serologically screened donor human placenta, seeded onto collagen corneal shields, and incubated in tissue culture medium for 7 days. These collagen shields were placed over the PED and supported by an overlying soft contact lens. The collagen shields dissolved by 72 hours, and the contact lenses were removed after this time. This cycle was repeated every week until healing was achieved. As a crossover control, collagen shields without AECs were placed in the same eye 1 week before placing collagen shields containing AECs. The PED was assessed by vital staining and slit-lamp color photography.
  
  
  RESULTS
  The PEDs had a mean duration of 4 months and involved 20% to 37% of the corneal surface area, one case secondary to longstanding alkali injury and two cases attributable to neurotrophic keratopathy. No change in PED size was observed in those control eyes receiving collagen shields without AECs. Complete resolution of the PED was seen after two cycles of AEC-seeded collagen shield in one case, and four cycles in two cases, from 7 to 12 weeks following treatment in all patients. No loss of visual acuity was seen and clinical improvement was maintained in all cases, with a mean follow-up of 6.3 months.
  
  
  CONCLUSIONS
  Nonsurgical transplantation of tissue-cultured AECs on a collagen shield provides a promising approach to restoring the ocular surface in cases of PED.
authors.affiliation: Division of Cornea, External Disease and Refractive Surgery, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Dipak N
authors.initials: DN
authors.lastname: Parmar
authors.forename: Hassan
authors.initials: H
authors.lastname: Alizadeh
authors.forename: Shady T
authors.initials: ST
authors.lastname: Awwad
authors.forename: Haochuan
authors.initials: H
authors.lastname: Li
authors.forename: Sudha
authors.initials: S
authors.lastname: Neelam
authors.forename: R Wayne
authors.initials: RW
authors.lastname: Bowman
authors.forename: H Dwight
authors.initials: HD
authors.lastname: Cavanagh
authors.forename: James P
authors.initials: JP
authors.lastname: McCulley
mesh_terms: D000328:Adult; D000368:Aged; D000650:Amnion / Q000166:cytology*; D017690:Cell Transplantation; D003094:Collagen; D003263:Contact Lenses, Hydrophilic; D003316:Corneal Diseases / Q000150:complications / Q000601:surgery*; D018592:Cross-Over Studies; D004847:Epithelial Cells / Q000166:cytology / Q000637:transplantation*; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D046509:Tissue Culture Techniques; D023822:Tissue Engineering; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D003094:Collagen