Stable Corneal Epithelium Research Articles

Phosphorylcholine and KR12-Containing Corneal Implants in HSV-1-Infected Rabbit Corneas.

Severe HSV-1 infection can cause blindness due to tissue damage from severe inflammation. Due to the high risk of graft failure in HSV-1-infected individuals, cornea transplantation to restore vision is often contraindicated. We tested the capacity for cell-free biosynthetic implants made from recombinant human collagen type III and 2-methacryloyloxyethyl phosphorylcholine (RHCIII-MPC) to suppress inflammation and promote tissue regeneration in the damaged corneas. To block viral reactivation, we incorporated silica dioxide nanoparticles releasing KR12, the small bioactive core fragment of LL37, an innate cationic host defense peptide produced by corneal cells. KR12 is more reactive and smaller than LL37, so more KR12 molecules can be incorporated into nanoparticles for delivery. Unlike LL37, which was cytotoxic, KR12 was cell-friendly and showed little cytotoxicity at doses that blocked HSV-1 activity in vitro, instead enabling rapid wound closure in cultures of human epithelial cells. Composite implants released KR12 for up to 3 weeks in vitro. The implant was also tested in vivo on HSV-1-infected rabbit corneas where it was grafted by anterior lamellar keratoplasty. Adding KR12 to RHCIII-MPC did not reduce HSV-1 viral loads or the inflammation resulting in neovascularization. Nevertheless, the composite implants reduced viral spread sufficiently to allow stable corneal epithelium, stroma, and nerve regeneration over a 6-month observation period.

Allogenic simple limbal epithelial transplantation (alloSLET) from cadaveric donor eyes in patients with persistent corneal epithelial defects

Background/aimTo describe the clinical outcome of allogenic simple limbal epithelial transplantation (alloSLET) utilising tissue from cadaveric donor eyes after failed re-epithelialisation of the corneal surface.MethodsMedical records of 14 eyes from...

Cellular therapy of corneal epithelial defect by adipose mesenchymal stem cell-derived epithelial progenitors

BackgroundPersistent epithelial defects (PED), associated with limbal stem cell deficiency (LSCD), require ocular surface reconstruction with a stable corneal epithelium (CE). This study investigated CE reformation using human adipose mesenchymal stem cells (ADSC), which derived epithelial progenitors via mesenchymal-epithelial transition (MET).MethodsSTEMPRO human ADSC were cultured with specific inhibitors antagonizing glycogen synthase kinase-3 and transforming growth factor-β signaling, followed by culture under a defined progenitor cell targeted-epithelial differentiation condition to generate epithelial-like cells (MET-Epi), which were characterized for cell viability, mesenchymal, and epithelial phenotypes using immunofluorescence and flow cytometry. Tissue-engineered (TE) MET-Epi cells on fibrin gel were transplanted to corneal surface of the rat LSCD model caused by alkali injury. Epithelial healing, corneal edema, and haze grading, CE formation were assessed by fluorescein staining, slit lamp bio-microscopy, anterior segment optical coherence tomography, and immunohistochemistry.ResultsCD73high/CD90high/CD105high/CD166high/CD14negative/CD31negative human ADSC underwent MET, giving viable epithelial-like progenitors expressing δNp63, CDH1 (E-cadherin), epidermal growth factor receptor, integrin-β4, and cytokeratin (CK)-5, 9. Under defined epithelial differentiation culture, these progenitors generated MET-Epi cells expressing cell junction proteins ZO1 and occludin. When transplanted onto rat corneal surface with LSCD-induced PED, TE-MET-Epi achieved more efficient epithelial healing, suppressed corneal edema, and opacities, when compared to corneas without treatment or transplanted with TE-ADSC. CE markers (CK3, 12, and CDH1) were expressed on TE-MET-Epi-transplanted corneas but not in other control groups.ConclusionHuman ADSC-derived epithelial-like cells, via MET, recovered the CE from PED associated with LSCD. ADSC can be a viable adult stem cell source for potential autologous epithelial cell-based therapy for corneal surface disorders.

Clinical outcomes of xeno-free expansion and transplantation of autologous ocular surface epithelial stem cells via contact lens delivery: a prospective case series

IntroductionDepletion of limbal stem cells leads to a debilitating condition known as limbal stem cell deficiency, characterised by impaired corneal wound healing and poor vision. The aim of this study was to determine whether delivering progenitor cells on a contact lens is a viable and effective alternative to current transplantation techniques, which are complicated by biological and xenogeneic materials.MethodsSixteen eyes of 16 patients who had total (n = 14) and partial (n = 2) limbal stem cell deficiency (chemical burns, five eyes; iatrogenic causes, four eyes; aniridia, three eyes; trachoma-induced, two eyes; contact lens over-wear, one eye; and cicatrising conjunctivitis, one eye) and who had failed prior therapy were recruited prospectively into the study. Autologous limbal (n = 7) or conjunctival epithelial (n = 9) biopsies were harvested from patients and placed on the concave surface of silicone hydrogel contact lenses. Cells were expanded in culture with autologous serum and transplanted onto the ocular surface.ResultsRestoration of a transparent avascular and clinically stable corneal epithelium was attained in 10 of 16 eyes (63%) at a median follow-up time of 2.5 years (range of 0.8 to 5.8 years). Although minor complications occurred in two eyes of two patients because of contact lens insertion or removal, these were not associated with long-term sequelae.ConclusionsThis is the first and largest study to evaluate the mid-term outcomes of autologous limbal/conjunctival stem cell transplantation via a US Food and Drug Administration-approved contact lens, demonstrating that delivery of ocular progenitor cells via this procedure offers a viable, effective, and xeno-free alternative to current transplantation methodologies.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN012607000211460. Registered 17 April 2007.

Cultivated Limbal Epithelial Transplantation in Children With Ocular Surface Burns

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. To report the outcomes of autologous ex vivo cultivated limbal epithelial transplantation (CLET) in pediatric patients with LSCD after ocular burns. A retrospective, interventional case series of patients treated at the L. V. Prasad Eye Institute, Hyderabad, India. 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. 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. 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. 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. Autologous CLET was successful in restoring the ocular surface and improving vision in almost half of the children blinded by ocular burns.

Self-retained Amniotic Membrane Transplantation for Recurrent Corneal Erosion

Purpose: To evaluate the efficacy of placement of sutureless self-retained cryopreserved amniotic membrane in treating recurrent corneal erosion (RCE).Methods: Eleven eyes of 9 consecutive patients with RCE received epithelial debridement and placement of ProKera® (Bio-Tissue, Inc, Miami, Florida, USA). Their clinical outcomes were retrospectively reviewed.Results: Although corneal signs suggestive of RCE were found in 7 of 11 eyes, diagnosis of the remaining 4 eyes, including two eyes with predominant lid discomfort, was not made until the use of the cellulose sponge test to elicit a wrinkled epithelium. After debridement and placement of ProKera®, complete epithelialization was noted in all eyes in 4 to 7 days. During the follow up of 13.7 ± 2.2 months, one eye recurred and required repeated treatment. Afterwards, all eyes were asymptomatic and regained a smooth and stable corneal epithelium. Best-corrected visual acuity was improved to at least 20/30 in all 6 eyes complaining of blurry vision and involving the visual axis.Conclusions: Debridement followed by placement of self-retained cryopreserved amniotic membrane via ProKera® can be performed in the office for treating RCE. Further studies to validate its efficacy in comparison to other surgeries are warranted.

Clinical transplantation ofex vivoexpanded autologous limbal epithelial cells using a culture medium with human serum as single supplement: a retrospective case series

Presently, our clinic is the only centre in Scandinavia that offers patients with corneal surface pathology including limbal stem cell deficiency (LSCD) transplantation of ex vivo expanded limbal epithelial cells (LECs). We here present clinical data of the first nine patients with LSCD who were transplanted with autologous LECs expanded in medium completely free of any animal-derived products and non-human/recombinant growth factors (including Cholera Toxin), and with autologous human serum as the only growth supplement. We conducted a noncomparative retrospective study of patients with LSCD at our centre between 2009 and 2011. The diagnosis was based on history and clinical signs. A biopsy was taken from healthy limbus, and the epithelium was expanded on amniotic membrane (AM) in medium containing autologous serum and subsequently transplanted to the affected eye. Successful outcome was defined as relief of pain and photophobia and/or improved best corrected visual acuity (BCVA) and/or reestablishment of a stable corneal epithelium and regression of corneal vascularization. Five of the nine transplanted patients (55.6%) had an improvement in either subjective symptoms or objective findings (11- to 28-month follow-up). Our clinical study shows that patients with LSCD can be treated successfully with transplantation of LECs expanded ex vivo in a medium with autologous serum as the only growth supplement. The use of this novel culture system, which is devoid of animal-derived products and non-human/recombinant growth factors (including Cholera Toxin), reduces the risks of inter-species disease transmission and host immune responses to xenogenic proteins, both obvious advantages for the patient.

Limbal allografting from related live donors for limbal stem cell deficiency secondary to ocular chemical burn

To investigate the efficacy and complications of limbal allografting from related live donors (RL-LAT) for limbal stem cell deficiency secondary to ocular chemical burn. Retrospective comparative case series. Limbal allografting from related live human leukocyte antigen (HLA)-matched (n = 10) and-unmatched donors (n = 2) was performed in 12 consecutive patients (12 eyes) with limbal stem cell deficiency secondary to ocular chemical burn, including 9 alkali burn and 3 acid burn; whereas allolimbal cadaver transplant was performed in another 15 patients in Zhongshan Ophthalmic Center between April 2006 to December 2007. Systemic cyclosporine A was administered to later eight recipients in living related donor group and all patients in cadaver donor group. Main outcome measures were restoration of corneal epithelium, reduction in corneal vascularization, improved corneal clarity, and visual improvement. Mean follow-up was (11.4 ± 3.6) months (from 12 to 27). In living related donor group, ten patients (83.3%) achieved initially reepithelialize, and epithelial healing time was (9.6 ± 3.4) d. Nine patients (75.0%) achieved stable ocular surface (stable corneal epithelium, decreased vascularization of corneal surface, and reduced corneal opacification). However, in seven eyes (77.8%) achieved stable ocular surface, gradual recurrence of peripheral corneal vascularization occurred after 5 to 8 months postoperatively. Whereas in cadaver donor group, twelve patients (80.0%) achieved initially reepithelialize, and epithelial healing time was (11.2 ± 4.6) d. Seven patients (46.7%) achieved stable ocular surface. However, in all seven eyes achieved stable ocular surface, gradual recurrence of peripheral corneal vascularization occurred after 4 to 10 months postoperatively. The differences of both the rate of initially reepithelialize and epithelial healing time between these two groups showed no statistical significance (χ(2) = 1.764, P = 0.117; t = 0.116, P = 0.133, respectively). However, the differences of both the successful rate of ocular surface reconstruction and the recurrent rate of corneal vascularization during the follow-up period between these two groups were statistically significant (χ(2) = 4.158, P = 0.015; χ(2) = 3.463, P = 0.022, respectively). In living related donor group, features of graft rejection developed in two patients with postoperative stable ocular surface, Both rejected recipients had one among HLA-matched and one among-unmatched respectively. Whereas in cadaver donor group, features of graft rejection developed in three patients with postoperative stable ocular surface. None of the donor eyes had any complications. Limbal allografting from related live donors is more effective to reconstruct the ocular surface of limbal stem cell deficiency secondary to ocular chemical burn than allolimbal cadaver transplant. HLA-matched limbal allografting could reduce postoperative graft rejection and systemic cyclosporine A is useful in ensuring long-term survival.

Midterm Outcomes of Autologous Cultivated Limbal Stem Cell Transplantation With or Without Penetrating Keratoplasty

To report the midterm outcomes of autologous limbal stem cell transplantation cultivated on amniotic membrane (AM) with or without subsequent penetrating keratoplasty (PKP) in patients with total unilateral limbal stem cell deficiency (LSCD). Eight eyes of 8 consecutive patients with unilateral total LSCD underwent autologous limbal stem cell transplantation cultivated on AM. Four eyes underwent subsequent optical PKP. Main outcome measures were corneal vascularization and transparency. The patients were followed for 34.0 +/- 13.5 months (6-48 months). Seven cases had a stable corneal epithelium with marked decrease in opacification and vascularization. Progressive sectorial conjunctivalization was evident in all cases with subsequent PKP at the last follow-up. Primary failure was observed in one case because of exposure. Transplantation of autologous stem cells cultivated on AM with or without subsequent PKP seems to be an effective way for visual rehabilitation in total LSCD. More work with more cases and longer follow-up are needed to optimize this procedure to provide and maintain an adequate supply of limbal stem cells in these patients.

Successful Clinical Implementation of Corneal Epithelial Stem Cell Therapy for Treatment of Unilateral Limbal Stem Cell Deficiency

The corneal epithelium is maintained by a population of stem cells known as limbal stem cells (LSCs) due to their location in the basal layer of the outer border of the cornea known as the limbus. Treatment of limbal stem cell deficiency (LSCD) has been achieved with transplantation of ex vivo expanded LSCs taken from a small biopsy of limbus. This is a relatively new technique, and as such, specific national or international guidance has yet to be established. Because of the lack of such specific guidance, our group has sought to minimize any risk to the patient by adopting certain modifications to the research methodologies in use at present. These include the replacement of all non-human animal products from the culture system and the production of all reagents and cultures under Good Manufacturing Practice conditions. In addition, for the first time, a strictly defined uniform group of patients with total unilateral LSCD and no other significant ocular conditions has been used to allow the success or failure of treating LSCD to be attributable directly to the proposed stem cell therapy. A prospectively designed study with strict inclusion and exclusion criteria was used to enroll patients from our database of patients with unilateral LSCD. Eight eyes of eight consecutive patients with unilateral total LSCD treated with ex vivo expanded autologous LSC transplant on human amniotic membrane (HAM) with a mean follow-up of 19 (RANGE) months were included in the study. Postoperatively, satisfactory ocular surface reconstruction with a stable corneal epithelium was obtained in all eyes (100%). At last examination, best corrected visual acuity improved in five eyes and remained unchanged in three eyes. Vision impairment and pain scores improved in all patients (p < .05). This study demonstrates that transplantation of autologous limbal epithelial stem cells cultured on HAM without the use of non-human animal cells or products is a safe and effective method of reconstructing the corneal surface and restoring useful vision in patients with unilateral total LSCD.

Ocular Surface Reconstruction

The most difficult part in ocular surface reconstruction for total limbal stem cell deficiency is restoring a healthy and stable corneal epithelium. Recently, there has been a shift toward a cellular-based transplantation that eliminates the need for harvesting large amounts of limbal tissues from a living donor. The autologous oral epithelium can be used as a source for ocular surface reconstruction instead of the limbal epithelial cells. This paper describes the method of harvesting autologous oral epithelial cells, culturing the cells on the amniotic membrane, and transplanting the amniotic membranewith the cultured oral epithelial cells on the ocular surface after removal of the fibrovascular scar tissue. Once the corneal epithelium is stable, penetrating keratoplasty may be performed at a later stage to restore the corneal clarity. (Tech Ophthalmology 2009;7: 118Y123) HISTORICAL REVIEW Ocular surface diseases with partial or total stem cell deficiency can usually be distinguished into 2 types: (a) diseases with a conjunctivalized cornea, where there is a viable tear film and the surface is wet, and (b) a completely dry and keratinized ocular surface. The former may be subject to a series of procedures collectively termed ocular surface reconstruction, whereas in the latter, only keratoprosthesis can be performed. This paper will discuss the latest advances in ocular surface reconstruction and will focus on the shift from tissue transplantation, where autologous or allogenic limbal tissue is transplanted, to cellbased therapy, where epithelial cells are isolated and transplanted to the ocular surface using different carriers. The treatment strategy in ocular surface reconstruction involves a multistep approach (Table 1). Improving the ocular surface health is the first step, which includes managing tear film problems, controlling blepharitis, suppressing inflammation, and treating recurrent corneal epithelial erosions and chronic ulcers. The second step includes the major surgical procedures, which start with reconstruction of the fornices and symblepharon repair and lid surgery to repair entropion. The next surgical step, which is the most challenging part in ocular surface reconstruction is aimed at creating a stable corneal epithelium. This includes autologous or allogenic transplantation of limbal tissue or transplantation of cultured epithelial cells that were expanded ex vivo on a carrier. These procedures will be further discussed in the following paragraphs. If a stable ocular surface was established and the corneal stroma is opaque, the next surgical step is corneal transplantation. The third step is maintaining the ocular surface defense mechanisms by continuous attention to the tear film, lid problems, and epithelial integrity (Table 1). The mainstay of ocular surface reconstruction involves the creation of a stable surface epithelium. Twomajor approaches are available today to establish this goal (Table 2). The first approach involves tissue transplantation, whereas the second is based on cell therapy that involves ex vivo cultured epithelial cells. Tissue transplantation involves transplantation of the limbal region, which may be harvested either from the contralateral healthy eye (autologous limbal transplantation), a living related donor, or a cadaveric source (allogenic limbal transplantation). Autologous limbal transplantation was first described by Kenyon and Tseng in 1989 (Table 3) and is probably the most successful surgical procedure in ocular surface reconstruction. However, this procedure is not suitable in cases of bilateral limbal deficiency andmay be avoided in patients who are afraid of operating on their only eye. The safety and favorable results of this procedure have been demonstrated in many studies. Allogenic limbal transplantation is performed in cases of bilateral limbal deficiency. Its disadvantages include the need for a long-term systemic immune suppression, a high incidence of graft rejection, and gradual loss of the donor cells with time. TABLE 1. Treatment Strategies in Ocular Surface Diseases With Limbal Deficiency: A Multi-Step Approach

A Contact Lens-Based Technique for Expansion and Transplantation of Autologous Epithelial Progenitors for Ocular Surface Reconstruction

A healthy cornea is reliant on a distinct population of stem cells (SC) that replace damaged or aging epithelium throughout life. Depletion of the SC pool or damage to the niche can result in a blinding and painful condition known as limbal-SC deficiency (LSCD). Although current treatment strategies for reconstituting the ocular surface for patients suffering LSCD are promising, they are complicated by transferring autologous or allogeneic progenitors in the presence of animal, human, and synthetic products. We report on the safe and efficacy of a unique autologous SC transfer technique that utilizes an Food and Drug Administration-approved contact lens (CL) as the SC substrate and carrier for patients with LSCD. Three patients with LSCD due to aniridia (n=1) and posttreatment for recurrent ocular surface melanoma (n=2) were included. Limbal (n=2) or conjunctival biopsies (n=1) were harvested and progenitors expanded ex vivo on therapeutic CLs in the presence of autologous serum. Cell-laden CLs were transferred to the patient's corneal surface and clinical outcome measures were recorded (follow-up range, 8-13 months). A stable transparent corneal epithelium was restored in each patient. There was no recurrence of conjunctivalization or corneal vascularization, and a significant improvement in symptom score occurred in all patients. Best-corrected visual acuity was increased in all eyes after the procedure. Ex vivo expansion of ocular surface epithelium in the presence of autologous serum and transplantation with the aid of a soft CLs is a promising new technique capable of achieving ocular surface rehabilitation.

Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

To evaluate the results of sutureless amniotic membrane (AM) transplantation using fibrin glue for reconstructing corneal surfaces with partial limbal stem cell deficiency (LSCD). Retrospective noncomparative interventional case series. Eleven eyes of nine patients that had LSCD with 120 degrees to almost 360 degrees of limbal involvement underwent superficial keratectomy to remove the conjunctivalized pannus followed by AM transplantation using fibrin glue. Additional sutureless AM patch (ProKera; Bio-Tissue, Inc, Miami, Florida, USA) was used in seven patients, and mitomycin C was applied on the cornea in four eyes and during fornix reconstruction in seven eyes. The surgery was repeated in three eyes for residual pannus. During a mean follow-up of 14.2 +/- 7.7 months (range, six to 26 months), all eyes maintained a smooth and stable corneal epithelial surface without recurrent erosion or persistent epithelial defect, and showed less stromal cloudiness and vascularization. Best-corrected visual acuity improved in nine eyes (81.8%). Corneal epithelialization proceeded by epithelial growth over AM (n = 4), accompanied by dissolution of AM (n = 4) or a combination of both (n = 3). No complication was noted regarding initial or repeated uses of fibrin glue. AM transplantation using fibrin glue appears to be a safe and effective method of restoring a stable corneal epithelium for cases with partial LSCD. This approach avoids the need of transplanting limbal epithelial stem cells.

Epiteliectomía conjuntival sectorial y trasplante de membrana amniótica en insuficiencia limbar parcial

A 74-year-old man developed a partial limbal stem cell deficiency secondary to a chemical injury in the left eye. He was treated with a sectorial conjunctival epitheliectomy and amniotic membrane transplantation. After 3 weeks there was an intact, smooth and stable corneal epithelium. This case report emphasizes that conjunctival epitheliectomy and amniotic membrane transplantation appears to be a safe and effective method of restoring a stable corneal epithelium for cases of partial limbal stem cell deficiency.

Early Results of Penetrating Keratoplasty After Cultivated Limbal Epithelium Transplantation

To describe the early results of penetrating keratoplasty (PKP) in patients who had previously undergone cultivated limbal epithelium transplantation. Medical records of patients with limbal stem cell deficiency due to chemical burns who underwent PKP after cultivated limbal epithelium transplantation were reviewed for demographics, primary etiology, type of limbal transplantation, ocular surface stability, visual acuity, graft clarity, and complications. Histopathologic features of the recipient corneal buttons were studied with special attention to epithelial status. Of the 125 patients with limbal stem cell deficiency treated with cultivated limbal epithelium transplantation, 15 underwent PKP at a mean interval of 7 months (range, 2-12 months) following cultivated limbal epithelium transplantation (autologous, n = 11; allogenic, n = 4). All 4 patients treated with allogenic cultivated limbal epithelium transplantation were undergoing immunosuppressive therapy. Fourteen (93%) of the 15 eyes had a successful corneal graft with a stable corneal epithelium. Preoperative best-corrected visual acuity was less than 20/200 in 14 of the 15 eyes. At a mean +/- SD follow-up of 8.3 +/- 5.0 months after PKP, the best-corrected visual acuity was more than 20/60 in 8 eyes, 20/200 to 20/60 in 5 eyes, and less than 20/200 in 2 eyes. Three of the 15 eyes experienced corneal allograft rejection, which was managed successfully. One eye with graft rejection also had glaucoma. None of the limbal epithelial allografts showed signs of rejection. Early results of PKP following cultivated limbal epithelium transplantation are favorable when performed after stabilizing the ocular surface. Adequate immunosuppression is essential for allogenic cultivated limbal epithelium transplantation to avoid rejection. Corneal allografts can separately reject the limbal allografts.

Ophthalmic Applications of Preserved Human Amniotic Membrane: A Review of Current Indications

Preserved human amniotic membrane (AM) is currently being used for a wide spectrum of ocular surface disorders. The AM has a basement membrane, which promotes epithelial cell migration and adhesion. The presence of a unique avascular stromal matrix reduces inflammation, neovascularization and fibrosis. The basic tenets of amniotic membrane transplantation (AMT) are to promote re-epithelialization, to reconstruct the ocular surface and to provide symptomatic relief from surface aberrations. AMT is a useful technique for reconstruction of surface defects resulting from removal of surface tumors and symblephara. AMT has effectively restored a stable corneal epithelium in eyes with, persistent epithelial defects and corneal ulcers. In the setting of acute ocular burns and SJS, AMT has satisfactorily reduced scarring and inflammation. AMT alone may be an effective alternative for partial limbal stem cell deficiency. However remarkable improvements in surface stability have resulted from concurrent AMT and limbal stem cell transplantation, wherein the limbal grafts are obtained from the normal fellow eye, living relative or cadaveric eye. In severe or bilateral cases, well being of the donor eye is a major concern. Currently, the most unique application of preserved human AM in ophthalmology is its use as a substrate for ex-vivo expansion of corneal and conjunctival epithelium. In this novel technique of tissue engineering, epithelial stem cells can be safely harvested and expanded on denuded AM. The resultant composite cultured tissue has been successfully transplanted to restore vision, as well as the structure and function of damaged ocular surfaces.

Amniotic membrane transplantation for partial limbal stem cell deficiency

AIMTo examine the efficacy, safety, and long term outcomes of amniotic membrane transplantation for corneal surface reconstruction in cases of partial limbal stem cell deficiency.METHODS17 eyes of 15 patients with...