Abstract
Objectives: This study compares the efficacy of stem cell transplantation in corneal regeneration and restoration of the limbic deficit in an experimental chemical burn in rabbits.
 Methods: Biopsy was performed of the limbus and the chemical burns for all rabbits, and we collected the amniotic membranes from a pregnant female rabbit. We kept a control group without transplantation, to study spontaneous and natural healing, and we transplanted the stem cells produced in vitro under the corneal epithelium burned. To compare the result, we tested a group for amniotic stem cell transplantation, a group for limbal stem cell graft, and another group for combined transplantation of both types of stem cells.
 Results: Transplanted rabbits develop permanent unilateral blindness due to a severe limbic deficit. The group receiving only amniotic stem cells shows temporary anatomical improvement without functional recovery. The two groups receiving limbal stem cells alone or combined with amniotic stem cells showed anatomical and functional satisfaction with quick recovery time for the combined transplantation.
 Conclusions: A simple chemical burn can establish permanent blindness. When the limbic deficit is important, spontaneous healing is not available. Transplantation of stem cell transplant is the only way to repair this deficit and regenerate the cornea. Only limbic stem cells can be sufficient. Amniotic stem cells can support and speed up the healing time when it combined to limbal stem cells graft. 
 Peer Review History: 
 Received 23 July 2020; Revised 14 August; Accepted 28 August, Available online 15 September 2020
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 Received file 
 
 Average Peer review marks at initial stage: 5.0/10
 Average Peer review marks at publication stage: 7.5/10
 Reviewer(s) detail:
 Name: Dr. Mohamed Amin El-Emam
 Affiliation: Department of Pharmacology and Therapeutics, Faculty of Pharmacy and Drug Manufacturing, Pharos University in Alexandria (PUA), Alexandria, Egypt.
 E-mail: mohamed.elemam@pua.edu.eg
 
 Name: Francesco Ferrara
 Affiliation: USL Umbria 1, Perugia, Italy
 E-mail: francesco.ferrara@uslumbria1.it
 
 Name: Maged Almezgagi
 Affiliation: Department of Immunology, Medical College of Qinghai University, Qinghai Xining 810001, China
 E-mail: 1902244017@qq.com
 
 Name: Dr. Asia Selman Abdullah
 Affiliation: University of Basrah, Iraq
 E-mail: asiaselman2016@gmail.com
 
 Comments of reviewer(s): 
Highlights
The ocular surface contains three adjacent epithelia: conjunctiva, limbus, and cornea
The ulcer was complicated by a severe limbic deficit and unilateral blindness (Group A)[5]
Various cellular and molecular processes started; first, the caustic agent destroys the epithelial cell membranes around the cornea and limbus and the extracellular matrix composed of structural proteins and signaling proteins[6,7,8], Two systems are activated, the metalloproteinases that break down proteins in the extracellular matrix and the system that converts plasminogen to plasmin
Summary
The ocular surface contains three adjacent epithelia: conjunctiva, limbus, and cornea. Cornea shows many roles in protecting internal structures from germs and particles and in protecting against ultraviolet rays[1,2] It is the transparent part of the eye, its location on the front surface of the eyeball often exposes it to accidental injuries. Various studies confirm the therapeutic success of amniotic membrane grafting associated or not with limbal stem cells[4]. This success is limited in time and often linked to later complications. Two types of stem cells were used for corneal repair in an experimental limbal deficit in rabbits; autologous cells from the limbus and amniotic cells amplified in vitro and administered as a single or combined transplant
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