Transplantation of autologous serum-derived cultivated corneal epithelial equivalents for the treatment of severe ocular surface disease.
OBJECTIVE
To evaluate the use of autologous serum (AS)-derived cultivated corneal epithelial transplantation for the treatment of severe ocular surface disease.


METHODS
Retrospective noncomparative case series.


METHODS
Nine eyes from 9 patients with total limbal stem cell deficiency were studied. These consisted of 2 eyes with Stevens-Johnson syndrome, 1 with chemical injury, 1 with ocular cicatricial pemphigoid, 1 with Salzmann corneal dystrophy, 1 with aniridia, 1 with graft-versus-host disease, and 2 with idiopathic ocular surface disease.


METHODS
Autologous serum obtained from patients was used for cultivating corneal epithelial cells on an amniotic membrane substrate. These AS-derived corneal epithelial equivalents were compared with those derived from fetal bovine serum (FBS)-supplemented medium. At the time of surgery, complete removal of the corneal pannus and conjunctiva up to 3 mm from the limbus was performed. Allogeneic (7 cases) and autologous (2 cases) AS-derived cultivated corneal epithelial equivalents were transplanted onto the ocular surface. Postoperative follow-up included serial slit-lamp examinations with fluorescein staining, as well as photographic documentation.


METHODS
Ocular surface reconstruction with corneal epithelialization, graft integrity, visual acuity, and postoperative complications.


RESULTS
The corneal epithelial sheets cultivated in AS- and FBS-supplemented media were morphologically similar, and demonstrated the normal expression of tissue-specific keratins and junctional specialization assembly proteins. After transplantation, complete corneal epithelialization was achieved within 2 to 5 days. All eyes demonstrated an improvement in visual acuity by > or =2 lines. During the follow-up period of 14.6+/-4.36 months, the corneal surface of all patients remained stable and transparent, without significant complications.


CONCLUSIONS
Transplantation of AS-derived cultivated corneal epithelial equivalents was shown to be a feasible method of treating patients with severe ocular surface disease. The use of AS is of clinical importance in the development of autologous xenobiotic-free bioengineered ocular surface equivalents for clinical transplantation.
Nakamura
Takahiro
T
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan.
Inatomi
Tsutomu
T
Sotozono
Chie
C
Ang
Leonard P K
LP
Koizumi
Noriko
N
Yokoi
Norihiko
N
Kinoshita
Shigeru
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion; D018929:Cell Culture Techniques / Q000379:methods; D017690:Cell Transplantation; D018920:Coculture Techniques; D003094:Collagen / Q000378:metabolism; D003316:Corneal Diseases / Q000601:surgery*; D051180:Desmoplakins / Q000378:metabolism; D004847:Epithelial Cells / Q000378:metabolism / Q000637:transplantation; D019573:Epithelium, Corneal / Q000166:cytology / Q000378:metabolism / Q000637:transplantation*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D039503:Integrin alpha6 / Q000378:metabolism; D007633:Keratins / Q000378:metabolism; D008297:Male; D008565:Membrane Proteins / Q000378:metabolism; D008875:Middle Aged; D010750:Phosphoproteins / Q000378:metabolism; D012189:Retrospective Studies; D044967:Serum; D062826:Zonula Occludens-1 Protein
D051180:Desmoplakins; D039503:Integrin alpha6; D008565:Membrane Proteins; D010750:Phosphoproteins; C569042:TJP1 protein, human; D062826:Zonula Occludens-1 Protein; D007633:Keratins; D003094:Collagen