title: Cultivated limbal epithelial transplantation in children with ocular surface burns.
abstract: OBJECTIVE
  Although several reports are available on the use of conventional and cultured limbal epithelium using various substrates in the treatment of limbal stem cell deficiency (LSCD), the patient populations studied have been largely adults. Thus, to our knowledge, the outcomes of this procedure exclusively in a pediatric population have not been reported previously.
  
  
  OBJECTIVE
  To report the outcomes of autologous ex vivo cultivated limbal epithelial transplantation (CLET) in pediatric patients with LSCD after ocular burns.
  
  
  METHODS
  A retrospective, interventional case series of patients treated at the L. V. Prasad Eye Institute, Hyderabad, India.
  
  
  METHODS
  Children up to 15 years with LSCD secondary to chemical or thermal injury who underwent CLET from April 1, 2001, through June 31, 2010, with a follow-up of at least 1 year, were included in the study.
  
  
  METHODS
  After a limbal biopsy specimen obtained from a healthy area of the limbus, the limbal epithelial cells were cultured on a denuded human amniotic membrane substrate using a xeno-free explant culture technique. A monolayer of cultivated epithelial cells along with the amniotic membrane was transplanted on the patient's affected eye after pannus excision. In cases of failure, the same procedure was repeated.
  
  
  METHODS
  Ocular surface stability and visual improvement were the primary and secondary outcome measures, respectively. Success was defined as a stable corneal epithelium without conjunctivalization. Eyes with conjunctivalization and persistent epithelial defects were classified as failures.
  
  
  RESULTS
  Of the 107 eyes of 107 patients included in this study, 73 eyes (68.2%) underwent 1 and 34 eyes (31.8%) underwent 2 autologous CLET procedures. At a mean follow-up of 3.4 years, 50 eyes (46.7%) achieved completely epithelialized, avascular, and stable ocular surfaces. At the final visit, 58 eyes (54.2%) had improvement in visual acuity of 0.2 or more logMAR units.
  
  
  CONCLUSIONS
  Autologous CLET was successful in restoring the ocular surface and improving vision in almost half of the children blinded by ocular burns.
authors.affiliation: Cornea and Anterior Segment Services, School of Medical Sciences, University of Hyderabad, Hyderabad, India.
authors.forename: Kunjal
authors.initials: K
authors.lastname: Sejpal
authors.forename: Mohammed Hasnat
authors.initials: MH
authors.lastname: Ali
authors.forename: Savitri
authors.initials: S
authors.lastname: Maddileti
authors.forename: Sayan
authors.initials: S
authors.lastname: Basu
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Ramappa
authors.forename: Ramesh
authors.initials: R
authors.lastname: Kekunnaya
authors.forename: Geeta K
authors.initials: GK
authors.lastname: Vemuganti
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001706:Biopsy; D002057:Burns, Chemical / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002058:Burns, Electric / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002478:Cells, Cultured; D002648:Child; D002675:Child, Preschool; D003229:Conjunctival Diseases / Q000209:etiology / Q000601:surgery; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D019573:Epithelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005126:Eye Burns / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D016850:Limbus Corneae / Q000473:pathology / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014785:Vision, Ocular; D014792:Visual Acuity