Factors influencing outcomes in cultivated limbal epithelial transplantation for chronic cicatricial ocular surface disorders.
OBJECTIVE
To analyze factors influencing clinical outcomes in cultivated limbal epithelial transplantation (CLET).


METHODS
Retrospective, observational case series.


METHODS
Twenty-seven eyes of 27 patients that had CLET for severe chronic cicatricial ocular surface disorders were studied. Two different cultivation methods were used to prepare epithelial sheets. Method 1 used the explant technique and neither feeder cells nor air-lifting were used. In Method 2, cell suspension technique and 3T3 feeder cells were used, and air-lifting was applied after cultivated cells became confluent. Clinical outcomes including corneal surface epithelialization and incidence of postoperative complications were studied. The relationship between the clinical outcome and type of cultivation method, original diseases, tear function, or preoperative ocular surface status was also studied.


RESULTS
Both cultivation methods produced transplantable epithelial sheets with corneal phenotype. With a mean follow-up period of 127 weeks, corneal epithelialization was achieved in 16 eyes (59.3%). Eyes that had CLET with Method 1 suffered more severe postoperative complications such as infection, ulceration, and perforation (P = .053). Eyes with Stevens-Johnson syndrome (SJS) had poor final corneal epithelialization compared with other diseases (P = .034). CLET was more successful when performed to conjunctivalized corneas compared with eyes with persistent epithelial defects or with dermalized corneas.


CONCLUSIONS
CLET offers new treatment modalities to chronic cicatricial ocular surface disorders with moderate success rates. The treatment is feasible for eyes with non-immune-mediated disorders with stable ocular surface conditions. Epithelial sheets with better structural integrity seem to be superior to obtain early postoperative epithelialization and to avoid serious postoperative complications.
Shimazaki
Jun
J
Department of Ophthalmology, Tokyo Dental College, Ichikawa-shi, Chiba, Japan. jun@eyebank.or.jp
Higa
Kazunari
K
Morito
Fumito
F
Dogru
Murat
M
Kawakita
Tetsuya
T
Satake
Yoshiyuki
Y
Shimmura
Shigeto
S
Tsubota
Kazuo
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D017690:Cell Transplantation; D002478:Cells, Cultured; D002908:Chronic Disease; D003229:Conjunctival Diseases / Q000473:pathology / Q000601:surgery*; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D004847:Epithelial Cells / Q000637:transplantation*; D005260:Female; D006801:Humans; D016850:Limbus Corneae / Q000166:cytology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010390:Pemphigoid, Benign Mucous Membrane / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D015415:Biomarkers