title: [New approaches to ocular surface reconstruction beyond the cornea].
abstract: BACKGROUND
  Reconstruction of the conjunctiva is an essential part of ocular surface reconstruction. Clinically applied and experimentally tested tissue- and stem-cell-based approaches are presented and evaluated.
  
  
  METHODS
  Current literature and our own results will be presented.
  
  
  RESULTS
  Autologous conjunctiva, mucous membrane of the mouth or nose, and amniotic membrane are routinely used for conjunctival reconstruction. Limitations are limited availability, involvement in autoimmune diseases, donor heterogeneity, and degradation in an inflamed environment. Experimentally tested matrices as tissues made from extracellular matrix proteins, synthetic polymers, temperature-sensitive culture dishes, and decellularized conjunctiva have been tested in vitro and partly in vivo. To replace conjunctival cells, cells of conjunctiva and mucous membrane of mouth and nose have been evaluated and show progenitor cell properties as well as secretory capacity (goblet cell differentiation).
  
  
  CONCLUSIONS
  Although different matrices are available for conjunctival reconstruction there is-due to specific limitations of existing tissues-a need for the development of new therapies for conjunctival replacement. Matrices produced in the laboratory have already been partly investigated in vivo and may thus be clinically applicable in the near future. Adult mucous membrane cells show many properties of conjunctival epithelium after expansion in vitro and thus are a promising cell source for conjunctival tissue engineering. Other stem cells sources require further evaluation.
authors.affiliation: Augenklinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Spaniol
authors.affiliation: Augenklinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Holtmann
authors.affiliation: Augenklinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Geerling
authors.affiliation: Augenklinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland. stefan.schrader@med.uni-duesseldorf.de.
authors.forename: S
authors.initials: S
authors.lastname: Schrader
mesh_terms: D000650:Amnion / Q000637:transplantation*; D003228:Conjunctiva / Q000601:surgery*; D019317:Evidence-Based Medicine; D005109:Extracellular Matrix / Q000637:transplantation*; D006801:Humans; D009092:Mucous Membrane / Q000637:transplantation*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D033581:Stem Cell Transplantation / Q000379:methods*; D016896:Treatment Outcome
keywords: Amniotic membrane; Conjunctiva; Decellularization; Extracellular matrix; Stem cells