title: Clinical outcomes of repeat autologous cultivated limbal epithelial transplantation for ocular surface burns.
abstract: OBJECTIVE
  To report the clinical outcomes of repeat autologous cultivated limbal epithelial transplantation in patients with recurrence of limbal stem cell deficiency after a failed primary procedure.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  This study included 50 patients, above 8 years of age, with clinically diagnosed unilateral limbal stem cell deficiency following ocular surface burns, treated between 2001 and 2010. Following failure of primary surgery all patients underwent a repeat limbal biopsy from the unaffected eye. The limbal cells were expanded ex vivo on a human amniotic membrane substrate for 10 to 14 days using a completely xeno-free explant culture technique. The resulting cultured epithelial monolayer and amniotic membrane were transplanted onto the patient's affected eye. All patients underwent a comprehensive ophthalmic examination of both eyes at every follow-up visit. Postoperative corneal surface stability, change in visual acuity, and complications were objectively analyzed.
  
  
  RESULTS
  At a mean follow-up of 2.3±1.4 (median: 1.96, range: 1 to 7.5) years, 33 of the 50 recipient eyes (66%) maintained a completely epithelialized, avascular, and clinically stable corneal surface. A 2-line improvement in visual acuity was seen in 38 of the 50 recipient eyes (76%). None of the donor eyes developed any clinical features of ocular surface disease, conjunctival overgrowth of the donor site, or decrease in vision throughout the follow-up period.
  
  
  CONCLUSIONS
  Repeat autologous cultivated limbal epithelial transplantation successfully restores corneal epithelial stability and improves vision in eyes with recurrence of limbal stem cell deficiency, following failed primary surgery for ocular burns, without adversely affecting donor eyes.
authors.affiliation: Cornea and Anterior Segment Services, Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, Department of Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Sayan
authors.initials: S
authors.lastname: Basu
authors.forename: Hasnat
authors.initials: H
authors.lastname: Ali
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000293:Adolescent; D000328:Adult; D002057:Burns, Chemical / Q000503:physiopathology / Q000601:surgery*; D002478:Cells, Cultured; D002648:Child; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D019573:Epithelium, Corneal / Q000166:cytology / Q000637:transplantation*; D005126:Eye Burns / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016850:Limbus Corneae / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000473:pathology; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult