Abstract
Purpose To analyse the recurrence of superficial neovascularisation after previous corneal surface reconstruction with cultivated corneal epithelial cells. Materials and Methods Forty-eight eyes underwent autologous transplantation of cultivated corneal epithelium to treat partial or total limbal stem cell deficiency caused by chemical or thermal injury. The carrier for the epithelial sheets was a denuded amniotic membrane. Follow-up was conducted for up to 120 months. Recurrent revascularisation (measured in terms of clock hours affected) was evaluated with slit-lamp examination and the support of confocal microscopy. Results During the long-term observation, only 7 eyes had stable epithelia with no neovascularisation from the conjunctiva. Nineteen eyes developed pathologic vessels in 1 quadrant, with additional 4 eyes developing them in 2 quadrants. Twelve patients developed subtotal or total conjunctivalisation of the corneal surface. They were referred for second cultivated epithelium transplantation (3 patients), allogenic keratolimbal transplantation (7 patients), or keratoprosthesis (2 patients). Six patients withdrew consent. The use of confocal scans of up to 100 µm in resolution enabled the detection of pathologic microvasculature originating from the conjunctiva and the exclusion of stromal vascular ingrowth. Conclusions Local ingrowth of the conjunctiva is a common complication after the transplantation of cultivated epithelial cells. Severe and progressive vascularisation inevitably leads to graft failure. However, if local ingrowth stops before reaching the central cornea, the treatment even with this complication can be considered a success.
Highlights
Limbal stem cell deficiency (LSCD) is defined as a lack of corneal epithelium renewal caused by damage or severe injury to the corneal epithelial stem cells of the limbus [1]
It has been confirmed that, during allogeneic transplantation, donor genetic material is not found despite the stabilisation of the corneal surface and the disappearance of disease features [12]. is may indicate that
E effectiveness of restoring the corneal epithelium with autologous cells can be confirmed by cytologic examination or confocal microscopy [13, 14]. e percentage of conjunctival and corneal epithelial cells allows the determination of the degree of deficiency of corneal epithelial cells, which allows us to indirectly check the effectiveness of our technique
Summary
Dariusz Dobrowolski ,1,2 Boguslawa Orzechowska-Wylegala ,3 Bogumil Wowra ,1 Ewa Wroblewska-Czajka ,1 Maria Grolik ,1 and Edward Wylegala 1. To analyse the recurrence of superficial neovascularisation after previous corneal surface reconstruction with cultivated corneal epithelial cells. Forty-eight eyes underwent autologous transplantation of cultivated corneal epithelium to treat partial or total limbal stem cell deficiency caused by chemical or thermal injury. During the long-term observation, only 7 eyes had stable epithelia with no neovascularisation from the conjunctiva. Twelve patients developed subtotal or total conjunctivalisation of the corneal surface. E use of confocal scans of up to 100 μm in resolution enabled the detection of pathologic microvasculature originating from the conjunctiva and the exclusion of stromal vascular ingrowth. Local ingrowth of the conjunctiva is a common complication after the transplantation of cultivated epithelial cells. If local ingrowth stops before reaching the central cornea, the treatment even with this complication can be considered a success
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