[Long-term results of autologous transplantation of limbal epithelium cultivated ex vivo for limbal stem cell deficiency].
OBJECTIVE
This study reports the long-term clinical outcome of autologous limbal epithelial cells cultivated ex vivo on intact amniotic membranes (AM) for ocular surface reconstruction in limbal stem cell deficiency (LSCD).


METHODS
A total of 61 eyes from 57 patients (46 males and 11 females) with LSCD were treated by transplantation of autologous limbal epithelial cells cultivated on intact AM. The etiology of the LSCD was chemical and thermal burns (n = 34), recurrent or primary large-sized pterygium (n = 12), mitomycin C and tumor excision-induced LSCD (n = 9), severe infectious keratitis (n = 3), perforating injury, epidermolysis bullosa and contact lens-associated keratopathy (each n = 1). Only eyes with a follow-up time of at least 12 months were included in the analysis. The main outcome end points were restoration of ocular surface integrity and improvement of visual acuity (VA).


RESULTS
The mean follow-up time was 50.8 ± 32.7 months. An entirely stable corneal surface was reconstructed in 46 (75.4%) eyes. Visual acuity significantly increased in 40 (65.6 %) eyes, was stable in 12 (19.7%) eyes and decreased in 9 eyes (14.8%). The mean visual acuity significantly increased (p < 0.0001) from 1.4 ± 0.91 LogMAR preoperatively to 0.8± 0.67 LogMAR postoperatively.


CONCLUSIONS
Transplantation of limbal epithelium cultivated ex vivo on intact AM leads to restoration of a stable corneal surface and resulted in a significant increase of visual acuity in most cases of LSCD. Autologous transplantation of cultivated limbal epithelium showed an excellent prognosis and outcome after long-term follow-up.
Zentrum für Augenheilkunde, Klinik für Erkrankungen des vorderen Augenabschnitts, Universität Duisburg-Essen, 45147, Essen, Deutschland.
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SL
Scholz
Zentrum für Augenheilkunde, Klinik für Erkrankungen des vorderen Augenabschnitts, Universität Duisburg-Essen, 45147, Essen, Deutschland.
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H
Thomasen
Zentrum für Augenheilkunde, Klinik für Erkrankungen des vorderen Augenabschnitts, Universität Duisburg-Essen, 45147, Essen, Deutschland.
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Hestermann
Zentrum für Augenheilkunde, Klinik für Erkrankungen des vorderen Augenabschnitts, Universität Duisburg-Essen, 45147, Essen, Deutschland.
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Dekowski
Zentrum für Augenheilkunde, Klinik für Erkrankungen des vorderen Augenabschnitts, Universität Duisburg-Essen, 45147, Essen, Deutschland.
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KP
Steuhl
Zentrum für Augenheilkunde, Klinik für Erkrankungen des vorderen Augenabschnitts, Universität Duisburg-Essen, 45147, Essen, Deutschland. daniel.meller@uk-essen.de.
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D
Meller
D000368:Aged; D064592:Autografts; D002986:Clinical Trials as Topic; D003316:Corneal Diseases / Q000473:pathology / Q000628:therapy*; D019573:Epithelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006801:Humans; D016850:Limbus Corneae / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
Cornea; Ex vivo expansion; Surface epithelium; Vision; Visual acuity