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Di Girolamo N. Biologicals and Biomaterials for Corneal Regeneration and Vision Restoration in Limbal Stem Cell Deficiency. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2401763. [PMID: 38777343 DOI: 10.1002/adma.202401763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/15/2024] [Indexed: 05/25/2024]
Abstract
The mammalian cornea is decorated with stem cells bestowed with the life-long task of renewing the epithelium, provided they remain healthy, functional, and in sufficient numbers. If not, a debilitating disease known as limbal stem cell deficiency (LSCD) can develop causing blindness. Decades after the first stem cell (SC) therapy is devised to treat this condition, patients continue to suffer unacceptable failures. During this time, improvements to therapeutics have included identifying better markers to isolate robust SC populations and nurturing them on crudely modified biological or biomaterial scaffolds including human amniotic membrane, fibrin, and contact lenses, prior to their delivery. Researchers are now gathering information about the biomolecular and biomechanical properties of the corneal SC niche to decipher what biological and/or synthetic materials can be incorporated into these carriers. Advances in biomedical engineering including electrospinning and 3D bioprinting with surface functionalization and micropatterning, and self-assembly models, have generated a wealth of biocompatible, biodegradable, integrating scaffolds to choose from, some of which are being tested for their SC delivery capacity in the hope of improving clinical outcomes for patients with LSCD.
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Affiliation(s)
- Nick Di Girolamo
- Mechanisms of Disease and Translational Research, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
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Kengpunpanich S, Chirapapaisan C, Ngowyutagon P, Chotikavanich S, Sikarinkul R, Taetrongchit N, Setthawong S, Prabhasawat P. Comparative analysis of long-term results of three epithelial cell transplantation procedures for treating limbal stem cell deficiency. Ocul Surf 2024; 32:71-80. [PMID: 38224776 DOI: 10.1016/j.jtos.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/17/2024]
Abstract
This study compared the long-term outcome of different epithelial transplantation techniques to treat limbal stem cell deficiency (LSCD). We conducted a retrospective 15-year comparative systematic cohort study of patients with LSCD who underwent either cultivated limbal epithelial transplantation (CLET), simple limbal epithelial transplantation (SLET), or cultivated oral mucosal epithelial transplantation (COMET). We reviewed the demographic data, etiology, LSCD severity, best-corrected visual acuity, surgical outcomes, and complications. A total of 103 eyes of 94 patients (mean age, 45.0 ± 16.4 years) with LSCD were enrolled. The most common cause of LSCD was chemical injury (42.7 %). The median follow-up time was 75 months. The success rates of CLET, SLET, and COMET were 45.5 %, 77.8 %, and 57.8 %, respectively. The 7-year survival rates after CLET, SLET, and COMET were 50.0 %, 72.2 %, and 53.2 %, respectively. Steven-Johnson syndrome (SJS) had a significantly lower survival rate than other causes (p < 0.001), but SLET had a significantly higher survival rate than CLET (p = 0.018) and COMET (p = 0.047). Visual improvement of more than four Snellen lines was achieved in 53.1 % of successful cases and 28.2 % of failed cases. SJS, Schirmer I test <5 mm, and the presence of postoperative recurrent epithelial defects were significant risk factors for a failed surgery. All epithelial transplantation techniques had favorable long-term surgical outcomes. More than half of the patients achieved a stable ocular surface and visual acuity improvement up to 7 years postoperatively. SLET tends to have a better surgical outcome than CLET and COMET, especially in patients with SJS.
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Affiliation(s)
- Sathiya Kengpunpanich
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chareenun Chirapapaisan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panotsom Ngowyutagon
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suksri Chotikavanich
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rosanun Sikarinkul
- Department of Ophthalmology, Golden Julibee Medical Center, Mahidol University, Bangkok, Thailand
| | - Nuttacha Taetrongchit
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Simaporn Setthawong
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pinnita Prabhasawat
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Bian Y, Jurkunas U. Ocular Chemical Injuries and Limbal Stem Cell Deficiency (LSCD): An Update on Management. Int Ophthalmol Clin 2024; 64:31-48. [PMID: 38525980 DOI: 10.1097/iio.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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Kate A, Basu S. Corneal blindness in the developing world: The role of prevention strategies. F1000Res 2024; 12:1309. [PMID: 38618022 PMCID: PMC11009612 DOI: 10.12688/f1000research.141037.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/16/2024] Open
Abstract
Corneal blindness is an important contributor to the burden of global blindness and has a greater prevalence in low-income countries of the developing world where resources and infrastructure are limited. The causes of corneal blindness too are different from high-income countries and include infectious keratitis, ocular trauma, and xerophthalmia. Persons with these indications tend to have unfavourable outcomes after corneal transplantation, limiting their chances of benefitting from this sight-saving procedure. However, most causes of corneal blindness in the developing world are preventable. This highlights the importance of understanding the unique challenges in these regions and the need for targeted interventions. This article discusses various prevention strategies, including primordial, primary, and secondary prevention, aimed at reducing the burden of corneal blindness in low-income countries. These include capacity building, training, and awareness campaigns to reduce the risk factors of ocular trauma, infectious keratitis, and to improve access to first aid. It is also important to promote safe eye practices and tackle nutritional deficiencies through public health interventions and policy changes. Providing the required training to general ophthalmologists in the management of basic corneal surgeries and diseases and enhancing the accessibility of eye care services in rural areas will ensure early treatment and prevent sequelae. Current treatment modalities belong to the tertiary level of prevention and are largely limited to corneal transplantation. In developing nations, there is a scarcity of donor corneal tissue necessitating an urgent expansion of eye banking services. Alternative approaches to corneal transplantation such as 3D printed corneas, cultured stem cells, and biomaterials should also be explored to meet this demand. Thus, there is a need for collaborative efforts between healthcare professionals, policymakers, and communities to implement effective prevention strategies and reduce the prevalence of corneal blindness in the developing world.
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Affiliation(s)
- Anahita Kate
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sayan Basu
- Centre for Ocular Regeneration (CORE), Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Sanders FWB, Huang J, Alió Del Barrio JL, Hamada S, McAlinden C. Amniotic membrane transplantation: structural and biological properties, tissue preparation, application and clinical indications. Eye (Lond) 2024; 38:668-679. [PMID: 37875701 PMCID: PMC10920809 DOI: 10.1038/s41433-023-02777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
The amniotic membrane is a single epithelial layer of the placenta. It has anti-inflammatory, anti-scarring, anti-angiogenic and possibly bactericidal properties. The basement membrane of the amniotic membrane acts as a substrate to encourage healing and re-epithelialisation. It has been used in many ocular surface diseases including persistent epithelial defects (corneal or conjunctival), chemical or thermal burns, limbal stem cell deficiency, cicatrising conjunctivitis, ocular graft versus host disease, microbial keratitis, corneal perforation, bullous keratopathy, dry eye disease, corneal haze following refractive surgery and cross-linking, band keratopathy, ocular surface neoplasia, pterygium surgery, and ligneous conjunctivitis. This review provides an up-to-date overview of amniotic membrane transplantation including the structural and biological properties, preparation and application, clinical indications, and commercially available products.
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Affiliation(s)
- Francis W B Sanders
- Department of Ophthalmology, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Jinhai Huang
- Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Jorge L Alió Del Barrio
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; and Cornea, Cataract and Refractive Surgery Department, VISSUM Corporation, Alicante, Spain
| | - Samer Hamada
- Corneo Plastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK
| | - Colm McAlinden
- Eye and ENT Hospital, Fudan University, Shanghai, China.
- Corneo Plastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK.
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, UK.
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Nurozler Tabakci B, Burcu A, Yalnız Akkaya Z, Şıngar E, Ozbek-Uzman S, Örnek F. Long-term ocular surface stability in conjunctivolimbal autograft and ocular surface safety in the donor eyes. Int Ophthalmol 2024; 44:75. [PMID: 38349582 DOI: 10.1007/s10792-024-03035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE The current study is aimed to present the long-term results of the patients who underwent conjunctivolimbal autograft (CLAU) as the primary operation in unilateral limbal stem cell deficiency and the ocular surface safety of the donor eyes. The patients were followed up for five years or longer. METHODS The records of all patients who underwent CLAU as the primary operation were retrospectively analyzed. Additional ocular surface operations, ocular surface stability, best-corrected visual acuity (BCVA), and ocular surface status of the donor eyes were investigated. RESULTS The mean age of the patients at the time of transplantation was 35.07 ± 12.9 (12-60). Twenty-nine eyes of 29 patients were followed up for an average of 97.82 ± 34.45 (60-186) months. Additional ocular surface operation was required in 27.58% (8/29) of the eyes in order to achieve a stable ocular surface. Ocular surface stability was achieved in 82.75% (24/29) of the eyes at the end of the follow-up period. BCVA increased from 1.78 ± 0.82 to 0.91 ± 0.92 logMAR at the last visit (p < 0.001). Corneal ectasia and vascularization developed in one donor eye in the fifth postoperative year. CONCLUSIONS CLAU tissues provide ocular surface stability with a successful vision result in the long term. CLAU theoretically carries risks including limbal stem cell deficiency in the donor eye. In the long-term follow-up of donor eyes after CLAU, ectasia and limbal stem cell deficiency were observed in one eye.
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Affiliation(s)
- Burcu Nurozler Tabakci
- Ophthalmology Department, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey.
| | - Ayşe Burcu
- Ophthalmology Department, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - Züleyha Yalnız Akkaya
- Ophthalmology Department, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - Evin Şıngar
- Ophthalmology Department, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - Selma Ozbek-Uzman
- Ophthalmology Department, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - Firdevs Örnek
- Ophthalmology Department, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
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Yang J, Tian M, Li J, Chen Y, Lin S, Ma X, Chen W, Hou L. Induction of human ESC-derived and adult primary multipotent limbal stem cells into retinal pigment epithelial cells and corneal stromal stem cells. Exp Eye Res 2024; 239:109778. [PMID: 38171475 DOI: 10.1016/j.exer.2023.109778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/05/2024]
Abstract
Human embryonic stem cell (hESC)- and human induced pluripotent stem cell (hiPSC)-derived retinal pigment epithelium (RPE) therapies are promising alternatives for the treatment of retinal degenerative diseases caused by RPE degeneration. The generation of autologous RPE cells from human adult donors, which has the advantage of avoiding immune rejection and teratoma formation, is an alternative cell resource to gain mechanistic insight into and test potential therapies for RPE degenerative diseases. Here, we found that limbal stem cells (LSCs) from hESCs and adult primary human limbus have the potential to produce RPE cells and corneal stromal stem cells (CSSCs). We showed that hESC-LSC-derived RPE cells (LSC-RPE) expressed RPE markers, had a phagocytic function, and synthesized tropical factors. Furthermore, during differentiation from LSCs to RPE cells, cells became pigmented, accompanied by a decrease in the level of LSC marker KRT15 and an increase in the level of RPE marker MITF. The Wnt signaling pathway plays a role in LSC-RPE fate transition, promotes MITF expression in the nucleus, and encourages RPE fate transition. In addition, we also showed that primary LSCs (pLSCs) from adult human limbus similar to hESC-LSC could generate RPE cells, which was supported by the co-expression of LSC and RPE cell markers (KRT15/OTX2, KRT15/MITF), suggesting the transition from pLSC to RPE cells, and typical polygonal morphology, melanization, RPE cell marker genes expression (TYR, RPE65), tight junction formation by ZO-1 expression, and the most crucial phagocytotic function. On the other hand, both hESC-LSCs and pLSCs also differentiated into CSSCs (LSC-CSSCs) that expressed stem cell markers (PAX6, NESTIN), presented MSC features, including surface marker expression and trilineage differentiation capability, like those in human CSSCs. Furthermore, the capability of pLSC-CSSC to differentiate into cells expressing keratocyte marker genes (ALDH3A1, PTGDS, PDK4) indicated the potential to induce keratocytes. These results suggest that the adult pLSC is an alternative cell resource, and its application provides a novel potential therapeutic avenue for preventing RPE dysfunction-related retinal degenerative diseases and corneal scarring.
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Affiliation(s)
- Juan Yang
- Laboratory of Developmental Cell Biology and Disease, State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Meiyu Tian
- Laboratory of Developmental Cell Biology and Disease, State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jinyang Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yu Chen
- Laboratory of Developmental Cell Biology and Disease, State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Shichao Lin
- Laboratory of Developmental Cell Biology and Disease, State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiaoyin Ma
- Laboratory of Developmental Cell Biology and Disease, State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wei Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ling Hou
- Laboratory of Developmental Cell Biology and Disease, State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Xu W, Li X. The effect of pterygium on front and back corneal astigmatism and aberrations in natural-light and low-light conditions. BMC Ophthalmol 2024; 24:7. [PMID: 38178053 PMCID: PMC10768295 DOI: 10.1186/s12886-023-03270-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND To investigate the effect of different sizes of pterygium on the front and back corneal topography, refractive changes and aberrations in natural-light and low-light conditions. METHODS Sixty subjects with unilateral primary nasal pterygium were enrolled in this study. All the patients' uncorrected, best spectacle-corrected visual acuity, corneal topographic aberration data in 3 mm and 7 mm areas were collected. The pterygium size was evaluated by the slit-lamp photography and Sirius Scheimpflug Analyzer. RESULTS The front topographic astigmatism values, corneal total aberrations, and higher-order aberrations in 3 mm and 7 mm areas were higher in the pterygium group than those in the control group. The pterygium horizontal length and thickness were moderately to strongly correlated with astigmatism and RMS of aberrations, while pterygium vertical length showed no or just mild correlation with the corneal astigmatism and aberrations. Compared to the readings in 3 mm area, the front and back corneal astigmatism and aberrations were larger in 7 mm area. CONCLUSIONS Pterygium led to visual impairment by inducing astigmatism and aberrations. In low-light condition, the visual function worsened due to increased corneal astigmatism values and aberrations.
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Affiliation(s)
- Weiwei Xu
- Shanghai Aier Eye Hospital, NO. 83 Wuzhong Road, Xuhui District, Shanghai, 200031, China
- Shanghai Aier Eye Institute, PR, NO. 83 Wuzhong Road, Xuhui District, Shanghai, 200031, China
| | - Xia Li
- Shanghai Aier Eye Hospital, NO. 83 Wuzhong Road, Xuhui District, Shanghai, 200031, China.
- Shanghai Aier Eye Institute, PR, NO. 83 Wuzhong Road, Xuhui District, Shanghai, 200031, China.
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Yu Y, Andreev AY, Rogovaya OS, Subbot AM, Domogatsky SP, Avetisov SE, Vorotelyak EA, Osidak EO. Matrix-Assisted Cell Transplantation for the Treatment of Limbal Stem Cell Deficiency in a Rabbit Model. Biomedicines 2024; 12:101. [PMID: 38255207 PMCID: PMC10813050 DOI: 10.3390/biomedicines12010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
With the development of regenerative medicine in ophthalmology, the identification of cells with high proliferative potential in the limbal area has attracted the attention of ophthalmologists and offered a new option for treatment in clinical practice. Limbal stem cell deficiency (LSCD) is an identified eye disease with a difficult and negative outcome, for which the traditional treatment is keratoplasty. This study sought to evaluate the efficacy of matrix-assisted cell transplantation consisting of in vitro-cultured autologous limbal stem cells (LSCs) and type I collagen for the treatment of LSCD in rabbits. LSCD was induced in 10 rabbits by a combination of mechanical limbectomy and alkali burns. Cells were cultured on a plate for 14 days before being transferred to a collagen-based matrix for another 7 days. Rabbits were divided into two groups as follows: the experimental group (five rabbits) received matrix-assisted cell transplantation, while the control group (five rabbits) received only conservative therapy with anti-inflammatory eye drops. During the postoperative period, all rabbits were examined using slit-lamp biomicroscopy with photo-registration and fluorescent staining, impression cytology and anterior segment optical coherence tomography (AS-OCT). Rabbits were euthanized at 30 and 120 days, and their corneas were processed for histology and immunohistochemistry. As a consequence, rabbits in the experimental group demonstrated the restoration of the corneal epithelium and transparency without epithelial defects. Moreover, goblet cells were absent in the central zone of the corneal epithelium. In conclusion, our new method of treatment enhanced the corneal surface and is an effective method of treatment for LSCD in rabbits.
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Affiliation(s)
- Yang Yu
- Department of Eye Diseases, I.M. Sechenov First Moscow State Medical University, 8-2, Trubetskaya Street, 119991 Moscow, Russia
| | - Andrey Yurevich Andreev
- Department of Eye Diseases, I.M. Sechenov First Moscow State Medical University, 8-2, Trubetskaya Street, 119991 Moscow, Russia
- Department of Pathologies of Optical Medium of the Eye, Krasnov Research Institute of Eye Diseases, 11A Rossolimo St., 119021 Moscow, Russia
- R&D Department, Imtek Ltd., 3rd Cherepkovskaya 15A, 121552 Moscow, Russia;
| | - Olga Sergeevna Rogovaya
- Laboratory of Cell Biology, Koltzov Institute of Developmental Biology Russian Academy of Science, 26, Vavilova St., 119334 Moscow, Russia
| | - Anastasia Mikhailovna Subbot
- Laboratory of Basic Research in Ophthalmology, Krasnov Research Institute of Eye Diseases, 11A Rossolimo St., 119021 Moscow, Russia
| | - Sergey Petrovich Domogatsky
- R&D Department, Imtek Ltd., 3rd Cherepkovskaya 15A, 121552 Moscow, Russia;
- Laboratory of Immunochemistry, FSBI National Medical Research Centre of Cardiology Name after Academician E.I. Chazov of the Ministry of Health of the Russian Federation, Academika Chazova St., 15A, 121552 Moscow, Russia
| | - Sergey Eduardovich Avetisov
- Department of Eye Diseases, I.M. Sechenov First Moscow State Medical University, 8-2, Trubetskaya Street, 119991 Moscow, Russia
- Department of Pathologies of Optical Medium of the Eye, Krasnov Research Institute of Eye Diseases, 11A Rossolimo St., 119021 Moscow, Russia
| | - Ekaterina Andreevna Vorotelyak
- Laboratory of Cell Biology, Koltzov Institute of Developmental Biology Russian Academy of Science, 26, Vavilova St., 119334 Moscow, Russia
| | - Egor Olegovich Osidak
- R&D Department, Imtek Ltd., 3rd Cherepkovskaya 15A, 121552 Moscow, Russia;
- Laboratory of Cellular Hemostasis and Thrombosis, Dmitry Rogachev National Medical Research Center of Paediatric Haematology, Oncology and Immunology, Samora Machel St., 1, 117997 Moscow, Russia
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Malyugin BE, Kalinnikova SY, Knyazer B, Gerasimov MY. Midterm Outcomes of Autologous Glueless Simple Limbal Epithelial Transplantation for Unilateral Limbal Stem Cell Deficiency. Cornea 2024; 43:45-51. [PMID: 37088892 DOI: 10.1097/ico.0000000000003279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/05/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this study was to report the midterm outcomes of glueless simple limbal epithelial transplantation (G-SLET) as a novel modification of limbal stem cell transplantation in patients with unilateral limbal stem cell deficiency (LSCD). METHODS This was a single-center, retrospective, interventional case series. Analysis of the 6 months interim outcomes was performed for 11 patients with unilateral LSCD who underwent G-SLET without simultaneous keratoplasty. The primary outcome measure was clinical success, which was defined as a completely epithelialized, avascular, and stable corneal surface. Secondary outcome measures included LSCD staging, improvement in visual acuity, and corneal grading of the recipient eye before and after the intervention. Adverse events were monitored throughout the study period. RESULTS At 6-month follow-up, clinical success was achieved in 9 of the 11 cases (81.8%) and partial success was observed in 2 cases (18.2%). Among the patients in the cohort, 54.5% improved to stage 0 LSCD. Seven patients experienced enhancement in visual acuity. All corneal grading parameters improved significantly. Six adverse events were registered in 5 cases and were successfully managed. An extended scar in the donor eye was observed in 1 patient. CONCLUSIONS This study demonstrated the high efficacy and safety of the G-SLET technique in the management of unilateral LSCD. G-SLET should be considered as a viable alternative to the"classic" SLET technique, specifically in the geographic areas where the availability of the fibrin glue is limited due to regulatory, economical, or any other reasons.
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Affiliation(s)
- Boris E Malyugin
- S. Fyodorov Eye Microsurgery Federal Institution, Moscow, Russia
- Department of Ophthalmology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia; and
- Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Lee YF, Yong DWW, Manotosh R. A Review of Contact Lens-Induced Limbal Stem Cell Deficiency. BIOLOGY 2023; 12:1490. [PMID: 38132316 PMCID: PMC10740976 DOI: 10.3390/biology12121490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/11/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023]
Abstract
Limbal stem cell deficiency (LSCD) is a pathologic condition caused by the dysfunction and destruction of stem cells, stem cell precursors and limbal cell niche in the corneal epithelium, leading to severe conjunctivalization of the cornea. Etiologies for LSCD span from congenital (aniridia), traumatic (chemical or thermal injuries), autoimmune (Stevens-Johnson syndrome) and iatrogenic disease to contact lens (CL) wear. Of these, CL wear is the least understood and is often a subclinical cause of LSCD. Even with recent advances in LSCD research, limitations persist in establishing the pathogenesis and treatment guidelines for CL-induced LSCD. A literature search was conducted to include original articles containing patients with CL-induced LSCD. This review will critically discuss the complex pathophysiology behind CL-induced LSCD, the underlying risk factors and epidemiology of the disease as well as methods to obtain a diagnosis. Various treatment options will be reviewed based on proposed treatment strategies.
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Affiliation(s)
- Yhu Fhei Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Dayna Wei Wei Yong
- Department of Ophthalmology, National University Hospital, Singapore 119074, Singapore
| | - Ray Manotosh
- Department of Ophthalmology, National University Hospital, Singapore 119074, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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Chaudhary S, Kate A, Chappidi K, Basu S, Shanbhag SS. Safety and Efficacy of Contact Lenses in Eyes After Simple Limbal Epithelial Transplantation. Cornea 2023; 42:1513-1519. [PMID: 36728263 DOI: 10.1097/ico.0000000000003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety and efficacy of contact lenses (CLs) in eyes after simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD). METHODS This retrospective study included 61 eyes with partial or total LSCD which underwent SLET and were fitted with corneal or scleral rigid gas-permeable CLs. The primary outcome measure was best-corrected visual acuity (BCVA) with CLs. RESULTS The median age at presentation was 22 years. The most common cause of LSCD was chemical injury [47/61 eyes (77%)]. Twenty-seven eyes (44%) were fitted with corneal rigid gas-permeable lenses, while 34 eyes (56%) were prescribed scleral lenses. The median duration of interval between SLET and CL trial was 10 months (interquartile range: 4-17). The median preoperative BCVA was logarithm of minimal angle of resolution (logMAR) 1.8. This improved to logMAR 1 ( P < 0.001) after SLET and to logMAR 0.6 ( P < 0.001) with CLs. Eyes with chemical injury (logMAR 1 vs. 0.6, P = 0.0001), grade 1 (logMAR 0.8 vs. 0.4, P < 0.0001), and grade 2 (logMAR 0.9 vs. 0.6, P = 0.004) corneal scarring had better improvement in BCVA with CLs. No complications were noted until the last follow-up visit. CONCLUSIONS CLs, both corneal and scleral lenses, provide significant visual improvement in eyes after SLET with residual corneal scarring. These can be safely prescribed in such eyes without any adverse effects. This option can be considered before offering keratoplasty in these eyes.
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Affiliation(s)
- Simmy Chaudhary
- The Cornea Institute, KAR Campus, L V Prasad Eye Institute, Hyderabad, India
- Bausch & Lomb Contact Lens Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Anahita Kate
- The Cornea Institute, L V Prasad Eye Institute, Vijaywada, India
| | - Kiranmayi Chappidi
- The Cornea Institute, L V Prasad Eye Institute, Vijaywada, India
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- The Cornea Institute, KAR Campus, L V Prasad Eye Institute, Hyderabad, India
- Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India; and
- Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, India
| | - Swapna S Shanbhag
- The Cornea Institute, KAR Campus, L V Prasad Eye Institute, Hyderabad, India
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Kasikci M, Korkmaz I, Palamar M, Egrilmez S, Yagci A, Barut Selver O. Evaluation of the factors that influence surgical outcome in conjunctival-limbal allograft transplantation. Eye (Lond) 2023; 37:2192-2196. [PMID: 36418907 PMCID: PMC10366148 DOI: 10.1038/s41433-022-02314-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/08/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the surgical results and the variables affecting the outcomes in conjunctival-limbal allograft transplantation (CLAL). METHODS Patients who underwent CLAL for limbal stem cell deficiency (LSCD) between 2007 and 2019 were included in the study. LSCD staging was performed according to the staging system developed by the 'Limbal Stem Cell Working Group'. Stage 1C and higher stage LSCD patients were included in the study. 'Successful surgical outcome' was defined as improvement in LSCD stage at 1 year postoperatively. RESULTS A total of 19 eyes of 19 LSCD patients were included. The mean age of the patients was 40.21 ± 14.65 (6-65) years, and the male/female ratio was 12/7. CLAL was performed in 9 (47.3%) patients with Stage 2B, 9 (47.3%) patients with Stage 3 and 1 (5.4%) with Stage 1C. LSCD aetiology; chemical injury (12), vernal keratoconjunctivitis (2), aniridia (1), corneal degeneration (1), and unknown (3). Surgery was successful in 52.6% of cases. Surgical success was associated with lower LSCD stage (p = 0.04). Lower grades of chemical injury at presentation and a longer time interval between injury and CLAL were associated with higher surgical success (p = 0.001; p = 0.001). The mean postoperative follow-up time was 50.77 ± 29.46 (6-98) months. CONCLUSIONS Despite graft rejection and long-term use of immunosuppressants, CLAL is still one of the most preferred techniques in the treatment of bilateral LSCD. Preoperative LSCD stage and degree of chemical burn are important factors affecting the surgical outcome. Also, CLAL surgery should not be rushed and should be performed when inflammation has subsided.
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Affiliation(s)
- Murat Kasikci
- Department of Ophthalmology, Mugla Training and Research Hospital, Mugla, Turkey
| | - Ilayda Korkmaz
- Department of Ophthalmology, Ege University, Izmir, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Ege University, Izmir, Turkey
| | - Sait Egrilmez
- Department of Ophthalmology, Ege University, Izmir, Turkey
| | - Ayse Yagci
- Department of Ophthalmology, Ege University, Izmir, Turkey
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Korkmaz I, Palamar M, Egrilmez S, Gurdal M, Yagci A, Barut Selver O. Evaluation of Limbal Stem Cell Transplant Success in Ocular Chemical Injury. EXP CLIN TRANSPLANT 2023; 21:684-690. [PMID: 34981716 DOI: 10.6002/ect.2021.0393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We evaluated limbal stem cell transplant success in limbal stem cell deficiency due to chemical injury at a tertiary eye care center in Turkey with a novel system for describing limbal stem cell deficiency, as developed by the Limbal Stem Cell Working Group. MATERIALS AND METHODS Medical records of 80 eyes of 80 patients after limbal stem cell transplant for limbal stem cell deficiency secondary to chemical injury were included, with patients grouped according to surgical procedure, ie, limbal autograft, limbal allograft, and cultivated limbal epithelial cell transplant. Surgical success was defined as improvement in postoperative year 1 of limbal stem cell deficiency stage. RESULTS Patients' mean age was 37.9 ± 15.7 years (range, 4-71 years). Male/female ratio was 2.4. Forty-five patients (56.3%) were injured with alkaline substance, and 16 (20%) with acid substance. Mean follow-up time was 60.3 ± 30.6 months (range, 6-118.6 months). Limbal autograft, allograft, and cultivated limbal epithelial cell transplants were performed in 58 (72.5%), 12 (15%), and 10 (12.5%) eyes, respectively. Intervals between injury and surgery in limbal autograft, limbal allograft, and cultivated limbal epithelial cell transplants were 43.3 ± 94.1 months (range, 0.5-592 months), 14.5 ± 10.6 months (range, 2.4-32.5 months), and 122.8 ± 158.9 months (range, 21.1-504 months),respectively (P = .02); and surgical success rates in each group were 65.5%, 41.7%, and 90%, respectively (P = .03). Overall surgical success rate was 65%. CONCLUSIONS Accurate determination of the limbal stem cell deficiency stage is crucial for proper evaluation of surgical success. Surgery type and interval between injury and surgery were the most important factors associated with higher surgical success rates. Despite the limited number of patients in the subgroups, the results were remarkable to emphasize the significance of a novel limbal stem cell deficiency scoring system.
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Affiliation(s)
- Ilayda Korkmaz
- From the Department of Ophthalmology, Ege University, Izmir, Turkey
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15
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Sharma S, Singh S, Shanbhag SS. Case Report: Simultaneous penetrating keratoplasty with autologous simple limbal epithelial transplantation as an alternative to keratoprosthesis. F1000Res 2023; 12:488. [PMID: 37455854 PMCID: PMC10349272 DOI: 10.12688/f1000research.133637.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction and importance: This case report highlights the multidisciplinary approach required to achieve successful anatomical and functional outcomes, in an eye with total limbal stem cell deficiency (LSCD) associated with underlying corneal scarring and thinning. Presentation of case: A 59-year-old gentleman had poor visual recovery in the right eye (RE) following accidental carbide blast, 1-year before presenting to us. The visual acuity was counting fingers and clinical examination revealed cicatricial entropion involving the upper eyelid, total LSCD, corneal scarring with a central descemetocele and cataract in the RE. Prior to ocular surface reconstruction, entropion correction was performed. Three months later, penetrating keratoplasty combined with cataract surgery and intraocular lens implantation (penetrating keratoplasty (PK) triple), with autologous simple limbal epithelial transplantation (SLET) was performed. The visual acuity was 20/100, 18 months after the surgery, with a clear well-epithelized corneal graft and stable ocular surface. Discussion: LSCD is caused by a decrease in the population and /or function of the limbal epithelial stem cells. Limbal stem cell transplantation (LSCT) is warranted in eyes with total LSCD. In eyes with coexisting corneal scarring, LSCT alone may be inadequate to restore the vision. These eyes require simultaneous or sequential lamellar or full-thickness corneal transplantation for visual rehabilitation. Though, the existing literature favors a sequential approach, where LSCT is performed first followed by corneal transplantation, under certain circumstances such as a thin underlying cornea like in our case, corneal transplantation may have to be combined with LSCT to achieve optimal outcomes. Conclusion: Combining autologous SLET with PK can be performed for visual rehabilitation in eyes with unilateral total LSCD and underlying corneal thinning. Corneal and limbal graft survival is prolonged if existing adnexal comorbidities are addressed before any surgical intervention is planned and adequate time interval is allowed for the surface inflammation to subside.
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Affiliation(s)
- Supriya Sharma
- Cornea and Anterior Segment Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swati Singh
- Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S. Shanbhag
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Sharma S, Singh S, Shanbhag SS. Case Report: Simultaneous penetrating keratoplasty with autologous simple limbal epithelial transplantation as an alternative to keratoprosthesis. F1000Res 2023; 12:488. [PMID: 37455854 PMCID: PMC10349272 DOI: 10.12688/f1000research.133637.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction and importance: This case report highlights the multidisciplinary approach required to achieve successful anatomical and functional outcomes, in an eye with total limbal stem cell deficiency (LSCD) associated with underlying corneal scarring and thinning. Presentation of case: A 59-year-old gentleman had poor visual recovery in the right eye (RE) following accidental carbide blast, 1-year before presenting to us. The visual acuity was counting fingers and clinical examination revealed cicatricial entropion involving the upper eyelid, total LSCD, corneal scarring with a central descemetocele and cataract in the RE. Prior to ocular surface reconstruction, entropion correction was performed. Three months later, penetrating keratoplasty combined with cataract surgery and intraocular lens implantation (penetrating keratoplasty (PK) triple), with autologous simple limbal epithelial transplantation (SLET) was performed. The visual acuity was 20/100, 18 months after the surgery, with a clear well-epithelized corneal graft and stable ocular surface. Discussion: LSCD is caused by a decrease in the population and /or function of the limbal epithelial stem cells. Limbal stem cell transplantation (LSCT) is warranted in eyes with total LSCD. In eyes with coexisting corneal scarring, LSCT alone may be inadequate to restore the vision. These eyes require simultaneous or sequential lamellar or full-thickness corneal transplantation for visual rehabilitation. Though, the existing literature favors a sequential approach, where LSCT is performed first followed by corneal transplantation, under certain circumstances such as a thin underlying cornea like in our case, corneal transplantation may have to be combined with LSCT to achieve optimal outcomes. Conclusion: Combining autologous SLET with PK can be performed for visual rehabilitation in eyes with unilateral total LSCD and underlying corneal thinning. Corneal and limbal graft survival is prolonged if existing adnexal comorbidities are addressed before any surgical intervention is planned and adequate time interval is allowed for the surface inflammation to subside.
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Affiliation(s)
- Supriya Sharma
- Cornea and Anterior Segment Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swati Singh
- Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S. Shanbhag
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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González-Gallardo C, Martínez-Atienza J, Mataix B, Muñoz-Ávila JI, Daniel Martínez-Rodríguez J, Medialdea S, Ruiz-García A, Lizana-Moreno A, Arias-Santiago S, de la Rosa-Fraile M, Garzon I, Campos A, Cuende N, Alaminos M, González-Andrades M, Mata R. Successful restoration of corneal surface integrity with a tissue-engineered allogeneic implant in severe keratitis patients. Biomed Pharmacother 2023; 162:114612. [PMID: 36989713 DOI: 10.1016/j.biopha.2023.114612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES Corneal diseases are among the main causes of blindness, with approximately 4.6 and 23 million patients worldwide suffering from bilateral and unilateral corneal blindness, respectively. The standard treatment for severe corneal diseases is corneal transplantation. However, relevant disadvantages, particularly in high-risk conditions, have focused the attention on the search for alternatives. METHODS We report interim findings of a phase I-II clinical study evaluating the safety and preliminary efficacy of a tissue-engineered corneal substitute composed of a nanostructured fibrin-agarose biocompatible scaffold combined with allogeneic corneal epithelial and stromal cells (NANOULCOR). 5 subjects (5 eyes) suffering from trophic corneal ulcers refractory to conventional treatments, who combined stromal degradation or fibrosis and limbal stem cell deficiency, were included and treated with this allogeneic anterior corneal substitute. RESULTS The implant completely covered the corneal surface, and ocular surface inflammation decreased following surgery. Only four adverse reactions were registered, and none of them were severe. No detachment, ulcer relapse nor surgical re-interventions were registered after 2 years of follow-up. No signs of graft rejection, local infection or corneal neovascularization were observed either. Efficacy was measured as a significant postoperative improvement in terms of the eye complication grading scales. Anterior segment optical coherence tomography images revealed a more homogeneous and stable ocular surface, with complete scaffold degradation occurring within 3-12 weeks after surgery. CONCLUSIONS Our findings suggest that the surgical application of this allogeneic anterior human corneal substitute is feasible and safe, showing partial efficacy in the restoration of the corneal surface.
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A Novel Technique of Amniotic Membrane Preparation Mimicking Limbal Epithelial Crypts Enhances the Number of Progenitor Cells upon Expansion. Cells 2023; 12:cells12050738. [PMID: 36899873 PMCID: PMC10001367 DOI: 10.3390/cells12050738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
We aimed to investigate whether a novel technique of human amniotic membrane (HAM) preparation that mimics the crypts in the limbus enhances the number of progenitor cells cultured ex vivo. The HAMs were sutured on polyester membrane (1) standardly, to obtain a flat HAM surface, or (2) loosely, achieving the radial folding to mimic crypts in the limbus. Immunohistochemistry was used to demonstrate a higher number of cells positive for progenitor markers p63α (37.56 ± 3.34% vs. 62.53 ± 3.32%, p = 0.01) and SOX9 (35.53 ± 0.96% vs. 43.23 ± 2.32%, p = 0.04), proliferation marker Ki-67 (8.43 ± 0.38 % vs. 22.38 ± 1.95 %, p = 0.002) in the crypt-like HAMs vs. flat HAMs, while no difference was found for the quiescence marker CEBPD (22.99 ± 2.96% vs. 30.49 ± 3.33 %, p = 0.17). Most of the cells stained negative for the corneal epithelial differentiation marker KRT3/12, and some were positive for N-cadherin in the crypt-like structures, but there was no difference in staining for E-cadherin and CX43 in crypt-like HAMs vs. flat HAMs. This novel HAM preparation method enhanced the number of progenitor cells expanded in the crypt-like HAM compared to cultures on the conventional flat HAM.
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Soleimani M, Cheraqpour K, Koganti R, Baharnoori SM, Djalilian AR. Concise Review: Bioengineering of Limbal Stem Cell Niche. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010111. [PMID: 36671683 PMCID: PMC9855097 DOI: 10.3390/bioengineering10010111] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/01/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
The corneal epithelium is composed of nonkeratinized stratified squamous cells and has a significant turnover rate. Limbal integrity is vital to maintain the clarity and avascularity of the cornea as well as regeneration of the corneal epithelium. Limbal epithelial stem cells (LESCs) are located in the basal epithelial layer of the limbus and preserve this homeostasis. Proper functioning of LESCs is dependent on a specific microenvironment, known as the limbal stem cell niche (LSCN). This structure is made up of various cells, an extracellular matrix (ECM), and signaling molecules. Different etiologies may damage the LSCN, leading to limbal stem cell deficiency (LSCD), which is characterized by conjunctivalization of the cornea. In this review, we first summarize the basics of the LSCN and then focus on current and emerging bioengineering strategies for LSCN restoration to combat LSCD.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Raghuram Koganti
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Seyed Mahbod Baharnoori
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ali R. Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
- Correspondence:
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20
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Diagnostic Algorithm for Surgical Management of Limbal Stem Cell Deficiency. Diagnostics (Basel) 2023; 13:diagnostics13020199. [PMID: 36673009 PMCID: PMC9858342 DOI: 10.3390/diagnostics13020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Limbal stem cell deficiency (LCSD) presents several challenges. Currently, there is no clearly defined systematic approach to LSCD diagnosis that may guide surgical tactics. METHODS The medical records of 34 patients with LSCD were analyzed. Diagnostic modalities included standard (visometry, tonometry, visual field testing, slit-lamp biomicroscopy with corneal fluorescein staining, Schirmer test 1, ultrasonography) and advanced ophthalmic examination methods such as anterior segment optical coherence tomography, in vivo confocal microscopy, impression cytology, and enzyme-linked immunoassay. RESULTS Standard ophthalmological examination was sufficient to establish the diagnosis of LSCD in 20 (58.8%) cases, whereas advanced evaluation was needed in 14 (41.2%) cases. Depending on the results, patients with unilateral LSCD were scheduled to undergo glueless simple limbal epithelial transplantation (G-SLET) or simultaneous G-SLET and lamellar keratoplasty. Patients with bilateral LSCD with normal or increased corneal thickness were enrolled in the paralimbal oral mucosa epithelium transplantation (pLOMET) clinical trial. CONCLUSIONS Based on the diagnostic and surgical data analyzed, the key points in LSCD diagnosis were identified, helping to guide the surgeon in selecting the appropriate surgical procedure. Finally, we proposed a novel step-by-step diagnostic algorithm and original surgical guidelines for the treatment of patients with LSCD.
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21
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Basu S. Editorial: Cell therapy to tissue engineering: Cutting edge research in ocular surface regeneration. Front Med (Lausanne) 2023; 10:1178946. [PMID: 37035344 PMCID: PMC10073732 DOI: 10.3389/fmed.2023.1178946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Sayan Basu
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- *Correspondence: Sayan Basu
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Ying PX, Fu M, Huang C, Li ZH, Mao QY, Fu S, Jia XH, Cao YC, Hong LB, Cai LY, Guo X, Liu RB, Meng FK, Yi GG. Profile of biological characterizations and clinical application of corneal stem/progenitor cells. World J Stem Cells 2022; 14:777-797. [PMID: 36483848 PMCID: PMC9724387 DOI: 10.4252/wjsc.v14.i11.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Corneal stem/progenitor cells are typical adult stem/progenitor cells. The human cornea covers the front of the eyeball, which protects the eye from the outside environment while allowing vision. The location and function demand the cornea to maintain its transparency and to continuously renew its epithelial surface by replacing injured or aged cells through a rapid turnover process in which corneal stem/progenitor cells play an important role. Corneal stem/progenitor cells include mainly corneal epithelial stem cells, corneal endothelial cell progenitors and corneal stromal stem cells. Since the discovery of corneal epithelial stem cells (also known as limbal stem cells) in 1971, an increasing number of markers for corneal stem/progenitor cells have been proposed, but there is no consensus regarding the definitive markers for them. Therefore, the identification, isolation and cultivation of these cells remain challenging without a unified approach. In this review, we systematically introduce the profile of biological characterizations, such as anatomy, characteristics, isolation, cultivation and molecular markers, and clinical applications of the three categories of corneal stem/progenitor cells.
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Affiliation(s)
- Pei-Xi Ying
- Department of Ophthalmology, Zhujiang Hospital, The Second Clinical School, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Min Fu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Chang Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200030, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200030, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200030, China
| | - Zhi-Hong Li
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou 510550, Guangdong Province, China
| | - Qing-Yi Mao
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Sheng Fu
- Hengyang Medical School, The University of South China, Hengyang 421001, Hunan Province, China
| | - Xu-Hui Jia
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yu-Chen Cao
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Li-Bing Hong
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Li-Yang Cai
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xi Guo
- Medical College of Rehabilitation, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Ru-Bing Liu
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Fan-ke Meng
- Emergency Department, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Guo-Guo Yi
- Department of Ophthalmology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
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Cultured Autologous Corneal Epithelia for the Treatment of Unilateral Limbal Stem Cell Deficiency: A Case Series of 15 Patients. Biomedicines 2022; 10:biomedicines10081958. [PMID: 36009509 PMCID: PMC9405734 DOI: 10.3390/biomedicines10081958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Damage to limbal epithelial stem cells can lead to limbal stem cell deficiency (LSCD). Current autologous treatment procedures for unilateral LSCD bear a significant risk of inducing LSCD in the donor eye. This complication can be avoided by grafting a stem cell containing cultured autologous corneal epithelium (CACE). The primary objective of this study was to demonstrate the safety of CACE grafted on eyes with LSCD. The secondary objective was to assess the efficacy of a CACE graft in restoring a self-renewing corneal surface with adequate anatomic structures, as well as improving the best corrected visual acuity (BCVA). Fifteen patients were grafted with a CACE on a fibrin gel produced from a 3 mm2 limbal biopsy harvested from the donor eye. Data were collected at baseline and after grafting. Follow-ups from 1 to 5 years were conducted. No major adverse events related to the CACE graft were observed. For every visit, an anatomic score based on corneal opacity as well as central vascularization and a functional score based on BCVA were determined. Safety was demonstrated by the low occurrence of complications. Anatomical (93%) and functional (47%) results are promising for improving vision in LSCD patients. Combined functional success and partial success rates with inclusion of BCVA were 53% [CI95: 27–79%] one year after CACE grafting. At the last follow-up, 87% [CI95: 60–98%] of the patients had attained corneal clarity. The outcomes demonstrate the safety of our technique and are promising regarding the efficacy of CACE in these patients.
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Jurkunas U, Johns L, Armant M. Cultivated Autologous Limbal Epithelial Cell Transplantation: New Frontier in the Treatment of Limbal Stem Cell Deficiency. Am J Ophthalmol 2022; 239:244-268. [PMID: 35314191 DOI: 10.1016/j.ajo.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/27/2022] [Accepted: 03/08/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Taking into consideration prior human experience with treating limbal stem cell deficiency (LSCD) with cultivated limbal epithelial cells (CLEC) from other countries, we have set a goal to optimize and standardize the techniques of CLEC preparation (called CALEC by our group) for the clinical trial in the United States. METHODS We performed an extensive literature review of all human trials, case series, and reports involving autologous cultivated limbal epithelial cell transplantation. Allogeneic cultivated limbal epithelial cell transplantations were reported only when combined with autologous studies. We also searched prior animal data aiding in detailing regulatory toxicology requirements. RESULTS Between 1997 and 2020, the analysis of human trials revealed 21 studies on autologous grafts, and 13 studies analyzing both autologous grafts and allogeneic grafts. Of a total of 34 studies, 6 studies used good manufacturing process (GMP) facilities, and 11 studies had no animal-derived products or murine feeder layers, whereas only 1 study had both. Overall, the treatment with autologous CLEC grafts was 68.9% successful. In total there were 6 preclinical studies using rabbits, serving as surrogate studies to assess the safety and toxicity of cultivated limbal epithelial cells for human trials. Based on prior human experience, we further optimized the manufacturing conditions with GMP-grade and serum and animal-free reagents, and developed cell characterization assays for the CALEC product release. CONCLUSIONS These data were used to develop a novel and consistent manufacturing process using only qualified and validated reagents for performing the first clinical trial on CALEC transplantation to treat LSCD in the United States.
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Affiliation(s)
- Ula Jurkunas
- From the Schepens Eye Research Institute (U.J., L.J.), Massachusetts Eye and Ear, Boston, Massachusetts, USA.
| | - Lynette Johns
- From the Schepens Eye Research Institute (U.J., L.J.), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Myriam Armant
- TransLab (M.A.), Translational Research Program, Boston Children's Hospital, Boston, Massachusetts, USA
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Akgun Z, Palamar M, Egrilmez S, Yagci A, Selver OB. Clinical Characteristics and Severity Distribution of Tertiary Eye Center Attendance by Ocular Chemical Injury Patients. Eye Contact Lens 2022; 48:295-299. [PMID: 35580512 DOI: 10.1097/icl.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To report demographic characteristics, types and grades of injury, regional distribution of injury severity, clinical findings, and long-term results of acute ocular chemical burns. METHODS Medical records of patients with chemical burns between 2010 and 2020 who were admitted to Ege University less than 72 hr after the injury were reviewed. Age, gender, cause of the burn, injury severity, initial and final best-corrected visual acuity, surgical intervention, and complications were recorded. The injury severity was graded according to Dua classification. RESULTS A total of 104 patients (137 eyes) were included. The mean age was 42.69±17.39 (7-90) years with a male-to-female ratio of 86:18. The most common causes were home (32.6%) and industrial accidents (45.1%). The causative agent percentages for alkaline, acid, and neutral were 49.0%, 35.5%, and 5.7%, respectively. The percentages of eyes in each grade (1-6) were 16.0%, 16.0%, 15.3%, 16.7%, 17.5%, and 18.2%, respectively. Complications mostly occurred in eyes with grade 2 or higher injuries (83.7%). The relationship between injury grade and limbal stem-cell deficiency was statistically significant (P<0.001). Surgery was mostly needed in grade 4 or higher injuries (44 eyes). CONCLUSION The severity of the burn is one of the most important prognostic factors in chemical burns. It is important to determine the spreading of the regional injury severity beside the global one to predict complication risk of the injuries. In the present study, the injury distribution was homogeneous in all grades. Limbal stem-cell deficiency development took place mostly in grade 5 and 6 burns as expected.
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Affiliation(s)
- Zeynep Akgun
- Department of Ophthalmology, Ege University Hospital, Izmir, Turkey
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Kate A, Basu S. A Review of the Diagnosis and Treatment of Limbal Stem Cell Deficiency. Front Med (Lausanne) 2022; 9:836009. [PMID: 35692544 PMCID: PMC9175008 DOI: 10.3389/fmed.2022.836009] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Limbal stem cell deficiency (LSCD) can cause significant corneal vascularization and scarring and often results in serious visual morbidity. An early and accurate diagnosis can help prevent the same with a timely and appropriate intervention. This review aims to provide an understanding of the different diagnostic tools and presents an algorithmic approach to the management based on a comprehensive clinical examination. Although the diagnosis of LSCD usually relies on the clinical findings, they can be subjective and non-specific. In such cases, using an investigative modality offers an objective method of confirming the diagnosis. Several diagnostic tools have been described in literature, each having its own advantages and limitations. Impression cytology and in vivo confocal microscopy (IVCM) aid in the diagnosis of LSCD by detecting the presence of goblet cells. With immunohistochemistry, impression cytology can help in confirming the corneal or conjunctival source of epithelium. Both IVCM and anterior segment optical coherence tomography can help supplement the diagnosis of LSCD by characterizing the corneal and limbal epithelial changes. Once the diagnosis is established, one of various surgical techniques can be adopted for the treatment of LSCD. These surgeries aim to provide a new source of corneal epithelial stem cells and help in restoring the stability of the ocular surface. The choice of procedure depends on several factors including the involvement of the ocular adnexa, presence of systemic co-morbidities, status of the fellow eye and the comfort level of the surgeon. In LSCD with wet ocular surfaces, autologous and allogeneic limbal stem cell transplantation is preferred in unilateral and bilateral cases, respectively. Another approach in bilateral LSCD with wet ocular surfaces is the use of an autologous stem cell source of a different epithelial lineage, like oral or nasal mucosa. In eyes with bilateral LSCD with significant adnexal issues, a keratoprosthesis is the only viable option. This review provides an overview on the diagnosis and treatment of LSCD, which will help the clinician choose the best option amongst all the therapeutic modalities currently available and gives a clinical perspective on customizing the treatment for each individual case.
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Affiliation(s)
- Anahita Kate
- The Cornea Institute, KVC Campus, LV Prasad Eye Institute, Vijayawada, India
| | - Sayan Basu
- The Cornea Institute, KAR Campus, LV Prasad Eye Institute, Hyderabad, India
- Prof. Brien Holden Eye Research Centre (BHERC), LV Prasad Eye Institute, Hyderabad, Telangana, India
- *Correspondence: Sayan Basu
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Elhusseiny AM, Soleimani M, Eleiwa TK, ElSheikh RH, Frank CR, Naderan M, Yazdanpanah G, Rosenblatt MI, Djalilian AR. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:259-268. [PMID: 35303110 PMCID: PMC8968724 DOI: 10.1093/stcltm/szab028] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
The corneal epithelium serves to protect the underlying cornea from the external environment and is essential for corneal transparency and optimal visual function. Regeneration of this epithelium is dependent on a population of stem cells residing in the basal layer of the limbus, the junction between the cornea and the sclera. The limbus provides the limbal epithelial stem cells (LESCs) with an optimal microenvironment, the limbal niche, which strictly regulates their proliferation and differentiation. Disturbances to the LESCs and/or their niche can lead to the pathologic condition known as limbal stem cell deficiency (LSCD) whereby the corneal epithelium is not generated effectively. This has deleterious effects on the corneal and visual function, due to impaired healing and secondary corneal opacification. In this concise review, we summarize the characteristics of LESCs and their niche, and present the current and future perspectives in the management of LSCD with an emphasis on restoring the function of the limbal niche.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mohammad Soleimani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Taher K Eleiwa
- Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Reem H ElSheikh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Charles R Frank
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Morteza Naderan
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Corresponding author: Ali R. Djalilian, Cornea Service, Stem Cell Therapy and Corneal Tissue Engineering Laboratory, Illinois Eye and Ear Infirmary, 1855 W. Taylor Street, M/C 648, Chicago, IL 60612, USA.
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Mohanna S, Elahi S, Panthier C, Gatinel D. Surgical approaches to autologous limbal stem cell transplantation (LSCT) following severe corneal chemical burns. J Fr Ophtalmol 2022; 45:352-357. [DOI: 10.1016/j.jfo.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
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Xue JF, Li DF, Wang YN, Chen C, Yang RF, Zhou QJ, Liu T, Xie LX, Dong YL. Midterm outcomes of penetrating keratoplasty following allogeneic cultivated limbal epithelial transplantation in patients with bilateral limbal stem cell deficiency. Int J Ophthalmol 2021; 14:1690-1699. [PMID: 34804858 DOI: 10.18240/ijo.2021.11.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the midterm outcomes of penetrating keratoplasty (PK) following allogeneic cultivated limbal epithelial transplantation (CLET) for bilateral total limbal stem cell deficiency (LSCD). METHODS Ten patients (10 eyes) with bilateral LSCD were enrolled in this prospective noncomparative case series study. Each participant underwent PK approximately 6mo after a CLET. Topical tacrolimus, topical and systemic steroids, and oral ciclosporin were administered postoperatively. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular surface grading scores (OSS), corneal graft epithelial rehabilitation, persistent epithelial defect (PED), immunological rejection, and graft survival rate were assessed. RESULTS The time interval between PK and allogeneic CLET was 6.90±1.29 (6-10)mo. BCVA improved from 2.46±0.32 logMAR preoperatively to 0.77±0.55 logMAR post-PK (P<0.001). Kaplan-Meier analysis of mean graft survival revealed graft survival rates of 100% at 12 and 24mo and 80.0% at 36mo. PEDs appeared in 5 eyes at different periods post-PK, and graft rejection occurred in 4 eyes. The total OSS decreased from 12.4±4.4 before allogeneic CLET to 1.4±1.51 after PK. CONCLUSION A sequential therapy design of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite the relatively high graft rejection rate.
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Affiliation(s)
- Jun-Fa Xue
- School of Medicine and Life Sciences, Shandong First Medical University, Jinan 271016, Shandong Province, China.,State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Dong-Fang Li
- State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Medical College, Qingdao University, Qingdao 266071, Shandong Province, China
| | - Ya-Ni Wang
- State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Medical College, Qingdao University, Qingdao 266071, Shandong Province, China
| | - Chen Chen
- State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Department of Ophthalmology, Shandong University, Jinan 250100, Shandong Province, China
| | - Ru-Fei Yang
- State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Qing-Jun Zhou
- State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Li-Xin Xie
- State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Yan-Ling Dong
- State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
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Shanbhag SS, Chanda S, Donthineni PR, Basu S. Surgical Management of Unilateral Partial Limbal Stem Cell Deficiency: Conjunctival Autografts versus Simple Limbal Epithelial Transplantation. Clin Ophthalmol 2021; 15:4389-4397. [PMID: 34785885 PMCID: PMC8590448 DOI: 10.2147/opth.s338894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the clinical outcomes of conjunctival autograft (CAG) versus simple limbal epithelial transplant (SLET) for management of unilateral partial limbal stem cell deficiency (LSCD). Methods This retrospective, comparative, interventional case series evaluated 30 eyes of 30 patients with unilateral partial LSCD. After corneal pannus dissection, 17 patients underwent CAG where graft was harvested from the ipsilateral or contralateral eye, while 13 patients underwent SLET where limbal biopsy was harvested from the contralateral eye. The primary outcome measure was anatomical success in the form of restoration of a completely epithelised, stable, and avascular corneal surface at last follow-up. Results Both groups were comparable in terms of age at time of surgery, preoperative best-corrected visual acuity, median duration since injury, number of clock hours of limbus involved, and number of previous surgeries performed. The most common etiology for LSCD was chemical burns in both groups. The median duration of post-operative follow-up was 5.6 months [interquartile range [(IQR): 3.6–15.1] in the CAG group versus 6.2 months (IQR: 4.5–12.2) in the SLET group (p=0.75)]. The anatomical success rates were 86.5 ± 8.9% in the CAG group and 28.3 ± 13.7% in the SLET group at final follow-up visit (p = 0.025). Most failures in both groups occurred within the first 8 months after surgery. Conclusion For eyes with unilateral partial LSCD secondary to chemical burns, CAG is a safe and effective method for restoring the corneal epithelium. Limbal transplantation may not be necessary for the treatment of partial LSCD.
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Affiliation(s)
- Swapna S Shanbhag
- The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sanjay Chanda
- The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Sayan Basu
- The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, Telangana, India.,Center for Ocular Regeneration (CORE), L.V. Prasad Eye Institute, Hyderabad, Telangana, India.,Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, Telangana, India
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Ganger A, Singh A, Kalaivani M, Gupta N, Vanathi M, Mohanty S, Tandon R. Outcomes of surgical interventions for the treatment of limbal stem cell deficiency. Indian J Med Res 2021; 154:51-61. [PMID: 34782530 PMCID: PMC8715695 DOI: 10.4103/ijmr.ijmr_1139_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & objectives: In the current scenario, with availability of different surgical procedures for limbal stem cell deficiency (LSCD), there exists no common consensus as to the standardization of the management protocol for the same. In addition, there also exists diversity in the views about the clinical diagnosis, ancillary investigations and clinical parameters. The objective of the present study was to evaluate the reported outcomes of surgical interventions for the management of LSCD. Methods: A systematic review of published literature on limbal stem cell transplantation (LSCT) was performed using Ovid Medline, Embase and PubMed for a duration of 2009 to 2019. Original studies including prospective, retrospective case series and randomized controlled trials, articles in English language, articles with access to full text and studies with more than or at least 10 patients were included in this review. Data related to clinical and visual outcomes were evaluated, and pool estimates of different surgeries were calculated using random-effects model and individually using Pearson’s Chi-square test. Results: A total of 1133 abstracts were evaluated. Finally, 17 studies were included for the analysis. Among these 17 studies, direct limbal lenticule transplantation was performed in five studies, of which autologous tissue from the fellow eye [conjunctival limbal autograft (CLAU)], allograft from a cadaver/live donor [keratolimbal allograft (KLAL)/conjunctival limbal allograft (CLAL)] and combination of CLAU plus KLAL were done in one, three and one studies, respectively. The ex vivo expanded cultivated limbal epithelial transplantation (CLET) was reported in six studies and simple limbal epithelial transplantation (SLET) in four studies. Two were comparative studies comparing CLET and CLAL (living-related CLAL) with cadaveric KLAL, respectively. Outcome analysis of the included studies showed significant heterogeneity. Calculated pool rate for various types of surgeries was calculated. The pool estimate for CLAL was 67.56 per cent [95% confidence interval (CI), 41.75-93.36; I2=83.5%, P=0.002]. For KLAL, this value was 63.65 per cent (95% CI, 31.38-95.91; I2=92.4%, P=0.000). Pool estimate for CLET was 78.90 per cent (95% CI, 70.51-87.28; I2=73.6%, P=0.001). Corresponding values for SLET were 79.08 per cent (95% CI, 74.10-84.07; I2=0.0%, P=0.619). CLAU and combination of CLAU plus KLAL were done in one study each; hence, statistical analysis could not be done. The functional outcome in terms of gain in visual acuity post-operatively was better in KLAL (P<0.005) and SLET group as compared to CLET group. Interpretation & conclusions: The present analysis suggests that though the anatomical success rates were almost identical between SLET, CLET, CLAL, and KLAL procedures, the functional success rates were better following KLAL and SLET procedures as compared to CLET. Decision for LSCT for cases of ocular burns based on either clinical judgement of the surgeon or individual diagnosis remains a suitable option.
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Affiliation(s)
- Anita Ganger
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Archita Singh
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - M Kalaivani
- Department of Biostatistics, Stem Cell Facility (DBT-Centre of Excellence for Stem Cell Research), All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Murugesan Vanathi
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sujata Mohanty
- Department of Cardiothoracic Surgery, Stem Cell Facility (DBT-Centre of Excellence for Stem Cell Research), All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Jameson JF, Pacheco MO, Nguyen HH, Phelps EA, Stoppel WL. Recent Advances in Natural Materials for Corneal Tissue Engineering. Bioengineering (Basel) 2021; 8:161. [PMID: 34821727 PMCID: PMC8615221 DOI: 10.3390/bioengineering8110161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022] Open
Abstract
Given the incidence of corneal dysfunctions and diseases worldwide and the limited availability of healthy, human donors, investigators are working to generate engineered cellular and acellular therapeutic approaches as alternatives to corneal transplants from human cadavers. These engineered strategies aim to address existing complications with human corneal transplants, including graft rejection, infection, and complications resulting from surgical methodologies. The main goals of these research endeavors are to (1) determine ideal mechanical properties, (2) devise methodologies to improve the efficacy of engineered corneal grafts and cell-based therapies, and (3) optimize transplantation of engineered tissue structures in the eye. Thus, recent innovations have sought to address these challenges through both in vitro and in vivo studies. This review covers recent work aimed at evaluating engineered materials, potential therapeutic cells, and the resulting cell-material interactions that lead to optimal corneal graft properties. Furthermore, we discuss promising strategies in corneal tissue engineering techniques and in vivo studies in animal models.
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Affiliation(s)
- Julie F. Jameson
- Department of Chemical Engineering, University of Florida, Gainesville, FL 32611, USA; (J.F.J.); (M.O.P.)
| | - Marisa O. Pacheco
- Department of Chemical Engineering, University of Florida, Gainesville, FL 32611, USA; (J.F.J.); (M.O.P.)
| | - Henry H. Nguyen
- Department of Materials Science and Engineering, University of Florida, Gainesville, FL 32611, USA;
| | - Edward A. Phelps
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA;
| | - Whitney L. Stoppel
- Department of Chemical Engineering, University of Florida, Gainesville, FL 32611, USA; (J.F.J.); (M.O.P.)
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A Decellularized Human Limbal Scaffold for Limbal Stem Cell Niche Reconstruction. Int J Mol Sci 2021; 22:ijms221810067. [PMID: 34576227 PMCID: PMC8471675 DOI: 10.3390/ijms221810067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
The transplantation of ex vivo expanded limbal epithelial progenitor cells (LEPCs) on amniotic membrane or fibrin gel is an established therapeutic strategy to regenerate the damaged corneal surface in patients with limbal stem cell deficiency (LSCD), but the long-term success rate is restricted. A scaffold with niche-specific structure and extracellular matrix (ECM) composition might have the advantage to improve long-term clinical outcomes, in particular for patients with severe damage or complete loss of the limbal niche tissue structure. Therefore, we evaluated the decellularized human limbus (DHL) as a biomimetic scaffold for the transplantation of LEPCs. Corneoscleral tissue was decellularized by sodium deoxycholate and deoxyribonuclease I in the presence or absence of dextran. We evaluated the efficiency of decellularization and its effects on the ultrastructure and ECM composition of the human corneal limbus. The recellularization of these scaffolds was studied by plating cultured LEPCs and limbal melanocytes (LMs) or by allowing cells to migrate from the host tissue following a lamellar transplantation ex vivo. Our decellularization protocol rapidly and effectively removed cellular and nuclear material while preserving the native ECM composition. In vitro recellularization by LEPCs and LMs demonstrated the good biocompatibility of the DHL and intrastromal invasion of LEPCs. Ex vivo transplantation of DHL revealed complete epithelialization as well as melanocytic and stromal repopulation from the host tissue. Thus, the generated DHL scaffold could be a promising biological material as a carrier for the transplantation of LEPCs to treat LSCD.
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Corneal Epithelial Stem Cells-Physiology, Pathophysiology and Therapeutic Options. Cells 2021; 10:cells10092302. [PMID: 34571952 PMCID: PMC8465583 DOI: 10.3390/cells10092302] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
In the human cornea, regeneration of the epithelium is regulated by the stem cell reservoir of the limbus, which is the marginal region of the cornea representing the anatomical and functional border between the corneal and conjunctival epithelium. In support of this concept, extensive limbal damage, e.g., by chemical or thermal injury, inflammation, or surgery, may induce limbal stem cell deficiency (LSCD) leading to vascularization and opacification of the cornea and eventually vision loss. These acquired forms of limbal stem cell deficiency may occur uni- or bilaterally, which is important for the choice of treatment. Moreover, a variety of inherited diseases, such as congenital aniridia or dyskeratosis congenita, are characterized by LSCD typically occurring bilaterally. Several techniques of autologous and allogenic stem cell transplantation have been established. The limbus can be restored by transplantation of whole limbal grafts, small limbal biopsies or by ex vivo-expanded limbal cells. In this review, the physiology of the corneal epithelium, the pathophysiology of LSCD, and the therapeutic options will be presented.
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Abstract
PURPOSE To assess the anatomic and visual results of the modified glueless simple limbal epithelial transplantation (G-SLET) in the treatment of unilateral limbal stem cell deficiency (LSCD). METHODS This is a retrospective analysis of 2 patients who received G-SLET for corneal reepithelization after unilateral eye burn. After the recipient bed preparation on the eye with LSCD, radial symmetrical superficial incisions were applied to the corneal periphery. Next, short (1 mm) slightly oblique or horizontal tunnels were formed in every incision. The precut limbal pieces from the healthy eye were inserted into the tunnels with a scleral portion forward. At the end of surgery, the amniotic membrane was sutured to the sclera outside the corneal limbus with a single running suture. RESULTS Slit lamp examination in the early postoperative period revealed that transplanted limbal pieces remained in place and were visible through the semitransparent amniotic membrane. The donor's eye had a small scar and light subconjunctival hemorrhage. Early and late postoperative periods were uneventful. Twelve months after surgery, the LSCD-affected cornea was entirely covered with tight and semitransparent epithelium. The donor's eye exhibited a small scar on the site of the biopsy. Visual improvement was achieved in case 2, but the vision did not improve due to the presence of a mature cataract in case 1. CONCLUSIONS Modified G-SLET technique could be an option for LSCD treatment in patients with unilateral eye disease in cases when fibrin glue is not available for the surgeon.
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Singh V, Tiwari A, Kethiri AR, Sangwan VS. Current perspectives of limbal-derived stem cells and its application in ocular surface regeneration and limbal stem cell transplantation. Stem Cells Transl Med 2021; 10:1121-1128. [PMID: 33951336 PMCID: PMC8284782 DOI: 10.1002/sctm.20-0408] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/11/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
Limbal stem cells are involved in replenishing and maintaining the epithelium of the cornea. Damage to the limbus due to chemical/physical injury, infections, or genetic disorders leads to limbal stem cell deficiency (LSCD) with partial or total vision loss. Presently, LSCD is treated by transplanting limbal stem cells from the healthy eye of the recipient, living-related, or cadaveric donors. This review discusses limbal-derived stem cells, the importance of extracellular matrix in stem cell niche maintenance, the historical perspective of treating LSCD, including related advantages and limitations, and our experience of limbal stem cell transplantation over the decades.
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Affiliation(s)
- Vivek Singh
- Stem Cell Biology Laboratory, Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, India
| | - Anil Tiwari
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Cornea and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Abhinav Reddy Kethiri
- Stem Cell Biology Laboratory, Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, India
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High-Resolution Optical Coherence Tomography Angiography Characteristics of Limbal Stem Cell Deficiency. Diagnostics (Basel) 2021; 11:diagnostics11061130. [PMID: 34205702 PMCID: PMC8233779 DOI: 10.3390/diagnostics11061130] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022] Open
Abstract
This study aimed to identify the anterior segment high-resolution optical coherence tomography (HR-OCT) and HR-OCT angiography (HR-OCTA) features suggestive of limbal stem cell deficiency (LSCD) as confirmed by both impression cytology (IC) and in vivo confocal microscopy (IVCM). This was a single-centre prospective cross-sectional study including 24 eyes of 22 patients with clinical suspicion of LSCD based on peripheral superficial corneal vascularisation and scarring. On IC and IVCM, performed and interpreted by blinded observers, 12 eyes each were diagnosed with and without LSCD. Additionally, 10 eyes of 5 healthy volunteers with no ocular pathology were also imaged. The 136 HR-OCT/A images of these 34 eyes were analysed with respect to 12 imaging parameters; the parameters most suggestive of LSCD were identified and the sensitivity and specificity were calculated. In the LSCD group, the most common aetiology was ocular chemical burns (83%), whereas in the non-LSCD group, the most common aetiology was viral keratitis (67%). Multiple logistic regression analysis revealed that mean epithelial reflectivity, mean stromal reflectivity, and mean superficial vascular density were the parameters that were diagnostic of LSCD on HR-OCT/A (p < 0.0001). A ratio of the mean epithelial reflectivity to stromal reflectivity of >1.29 corresponded with a high sensitivity (91.7%) and specificity (98.75%); while a mean superficial vascular density score of >0.38 corresponded with a sensitivity of 97.9% and specificity of 73.8%. In conclusion, HR-OCT/A as a non-invasive imaging modality could prove to be a useful tool for confirming the diagnosis of LSCD, with potential clinical and research applications.
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Tong CM, He B, Iovieno A, Yeung SN. Diagnosis and management of limbal stem cell deficiency, challenges, and future prospects. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1933441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C. Maya Tong
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Bonnie He
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Sonia N. Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
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Abstract
Purpose: To review the surgical management options in ocular chemical burn, including newer advances.Methods: Online literature search of published articles over last 5 years on surgical management of ocular chemical burn and newer advances were performed on December 30, 2020.Results: Following literature search and screening using adequate filters, 67 review articles on surgical management of ocular chemical burns were retrieved. The review talks about the surgical management options starting from Debridement in acute stage to various visual rehabilitative procedures in the chronic stage. The review also highlights the evolving surgical advances in this field.Conclusion: It is imperative to choose adequate surgical tool wherever applicable; current review discusses the role of each surgical option at different clinical stages in detail.
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Affiliation(s)
- Priyanshi Awasthi
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
| | - Prabhakar Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
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Han SB, Ibrahim FNIM, Liu YC, Mehta JS. Efficacy of Modified Amnion-Assisted Conjunctival Epithelial Redirection (ACER) for Partial Limbal Stem Cell Deficiency. ACTA ACUST UNITED AC 2021; 57:medicina57040369. [PMID: 33920151 PMCID: PMC8069281 DOI: 10.3390/medicina57040369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 01/06/2023]
Abstract
Background and objectives: the aim of this study was to analyze the efficacy of a modified “amnion-assisted conjunctival epithelial redirection (ACER)” technique for the treatment of partial limbal stem cell deficiency (LSCD). Materials and methods: the medical records of three patients with partial LSCD who underwent corneal surface reconstruction with modified ACER following superficial keratectomy were retrospectively studied. Briefly, in this technique, an inner amniotic membrane (AM) layer was applied on the corneal surface to promote corneal re-epithelialization. The outer AM layer was applied as a barrier to prevent the invasion of conjunctival epithelial cells into the cornea before the corneal surface was completely covered by corneal epithelial cells derived from the remaining intact limbal stem cells. Results: in all three cases, the outer AM layer successfully kept the conjunctival epithelium away from the corneal surface and prevented an admixture of conjunctival epithelial cells with corneal epithelial cells. In all three patients, the cornea was completely re-epithelized with epithelial cells derived from the remaining healthy limbal stem cells, and a clear visual axis was maintained without recurrence for a mean follow-up period of 37.3 ± 8.6 months. Conclusions: the preliminary results suggest that modified ACER appears to be a viable option for patients with partial LSCD.
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Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon 24289, Korea;
| | - Farah Nur Ilyana Mohd Ibrahim
- Singapore National Eye Centre, Singapore 168751, Singapore; (F.N.I.M.I.); (Y.-C.L.)
- Singapore Eye Research Institute, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Yu-Chi Liu
- Singapore National Eye Centre, Singapore 168751, Singapore; (F.N.I.M.I.); (Y.-C.L.)
- Singapore Eye Research Institute, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore 168751, Singapore; (F.N.I.M.I.); (Y.-C.L.)
- Singapore Eye Research Institute, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Correspondence: ; Tel.: +65-91825146; Fax: +65-08701316622
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Thokala P, Singh A, Singh VK, Rathi VM, Basu S, Singh V, MacNeil S, Sangwan VS. Economic, clinical and social impact of simple limbal epithelial transplantation for limbal stem cell deficiency. Br J Ophthalmol 2021; 106:923-928. [PMID: 33688000 PMCID: PMC9234414 DOI: 10.1136/bjophthalmol-2020-318642] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/21/2021] [Accepted: 02/05/2021] [Indexed: 12/25/2022]
Abstract
Aims To report the global uptake of simple limbal epithelial transplantation (SLET) and compare the economic, clinical and social outcomes of SLET with those of cultured limbal epithelial transplantation (CLET). Methods A comprehensive literature review and an online survey of eye surgeons were conducted to understand the efficacy and current uptake of SLET surgery. A de novo economic model was developed to estimate the cost savings with SLET compared with CLET. Our economic analysis is conducted from an Indian perspective, as this is where the technique originated. A scenario analysis using the UK cost data and a user-friendly Excel model is included to allow users to input the costs from their setting to estimate the cost savings with using SLET compared with using CLET Results The anatomical success with SLET in adults (72.6% (range 62%–80%)) was the same as CLET (70.4% (range 68%–80.9%)). For children, the outcome for SLET (77.8% (range 73%–83%)) was better than with CLET (44.5% (range 43%–45%)). In response to our informal questionnaire, 99 surgeons reported to have performed SLET on 1174 patients in total. They appreciated that SLET negates the requirement for costly tissue engineering facilities. Results of economic analysis suggested that SLET provided an estimated cost-savings of US$6470.88 for adults and US$6673.10 for children. In broad terms, the cost of SLET is approximately 10% of the cost of CLET for adults and 8% for children. Conclusion SLET offers a more accessible and financially attractive alternative to CLET to treat limbal stem cell deficiency.
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Affiliation(s)
- Praveen Thokala
- Health Economics and Decision Science, The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Aastha Singh
- Cornea and Anterior Segment Services, Dr Shroff's Charity Eye Hospital Delhi, New Delhi, Delhi, India
| | - Vijay Kumar Singh
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana, India.,Centre for Ocular Regeneration, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Varsha M Rathi
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana, India.,Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek Singh
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana, India .,Centre for Ocular Regeneration, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sheila MacNeil
- Department of Materials Science & Engineering, The University of Sheffield Kroto Research Institute, Sheffield, UK
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Prinz J, Mehta JS, Walter P, Fuest M. [Simple limbal epithelial transplantation (SLET) : A simple technique for the treatment of unilateral complete limbal stem cell deficiency. Video article]. Ophthalmologe 2021; 118:404-412. [PMID: 33683425 DOI: 10.1007/s00347-021-01346-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of simple limbal epithelial transplantation (SLET) is the regeneration of the corneal surface in unilateral complete limbal stem cell deficiency (LSCD). INDICATIONS SLET is indicated for unilateral complete LSCD. CONTRAINDICATIONS Contraindications include bilateral LSCD, severe corneal thinning, pronounced keratoconjunctivitis sicca, chronic inflammatory condition of the ocular surface, malposition of the eyelids and pronounced adhesions of the conjunctiva with trichiasis. SURGICAL TECHNIQUE A 1‑h biopsy is obtained from the superior limbus of the healthy donor eye. A 360° peritomy is performed on the LSCD eye and pannus tissue covering the cornea is removed. An amniotic membrane (AM) is glued to the corneal surface with fibrin. The donor tissue is then divided into 8-10 small pieces, which are placed on the AM sparing the visual axis and fixed by fibrin glue. A contact lens is placed on the eye. A surgical video, which is available online, shows the surgical technique in detail. FOLLOW-UP Examinations are necessary within the first postoperative week and 1 month after SLET, then every 3 months within the first postoperative year. Antibiotic eye drops should be applied 5 times daily until complete epithelialization. Topical steroids should be applied 6 times daily in the early postoperative period and can be tapered thereafter. Artificial tears can improve epithelial healing. Ideally, all eye drops should be preservative-free. The contact lens can be removed after 7-10 days. The AM dissolves within a few weeks. An epithelialization of the corneal surface can be observed by the second postoperative week. EVIDENCE A recent systematic review reported a stable epithelialized corneal surface in 78% of SLET cases after 1.5 years. An improvement of visual acuity of at least two lines was found in 69% of SLET cases.
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Affiliation(s)
- Julia Prinz
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapur, Singapur
- Singapore Eye Research Institute, Singapur, Singapur
| | - Peter Walter
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Matthias Fuest
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Guérin LP, Le-Bel G, Desjardins P, Couture C, Gillard E, Boisselier É, Bazin R, Germain L, Guérin SL. The Human Tissue-Engineered Cornea (hTEC): Recent Progress. Int J Mol Sci 2021; 22:ijms22031291. [PMID: 33525484 PMCID: PMC7865732 DOI: 10.3390/ijms22031291] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Each day, about 2000 U.S. workers have a job-related eye injury requiring medical treatment. Corneal diseases are the fifth cause of blindness worldwide. Most of these diseases can be cured using one form or another of corneal transplantation, which is the most successful transplantation in humans. In 2012, it was estimated that 12.7 million people were waiting for a corneal transplantation worldwide. Unfortunately, only 1 in 70 patients received a corneal graft that same year. In order to provide alternatives to the shortage of graftable corneas, considerable progress has been achieved in the development of living corneal substitutes produced by tissue engineering and designed to mimic their in vivo counterpart in terms of cell phenotype and tissue architecture. Most of these substitutes use synthetic biomaterials combined with immortalized cells, which makes them dissimilar from the native cornea. However, studies have emerged that describe the production of tridimensional (3D) tissue-engineered corneas using untransformed human corneal epithelial cells grown on a totally natural stroma synthesized by living corneal fibroblasts, that also show appropriate histology and expression of both extracellular matrix (ECM) components and integrins. This review highlights contributions from laboratories working on the production of human tissue-engineered corneas (hTECs) as future substitutes for grafting purposes. It overviews alternative models to the grafting of cadaveric corneas where cell organization is provided by the substrate, and then focuses on their 3D counterparts that are closer to the native human corneal architecture because of their tissue development and cell arrangement properties. These completely biological hTECs are therefore very promising as models that may help understand many aspects of the molecular and cellular mechanistic response of the cornea toward different types of diseases or wounds, as well as assist in the development of novel drugs that might be promising for therapeutic purposes.
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Affiliation(s)
- Louis-Philippe Guérin
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Gaëtan Le-Bel
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Pascale Desjardins
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Camille Couture
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Elodie Gillard
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Élodie Boisselier
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Richard Bazin
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Lucie Germain
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Sylvain L. Guérin
- CUO-Recherche, Médecine Régénératrice—Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1S 4L8, Canada; (L.-P.G.); (G.L.-B.); (P.D.); (C.C.); (E.G.); (É.B.); (R.B.); (L.G.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Québec, QC G1J 1Z4, Canada
- Département d’Ophtalmologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-418-682-7565
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Le Q, Chauhan T, Yung M, Tseng CH, Deng SX. Outcomes of Limbal Stem Cell Transplant: A Meta-analysis. JAMA Ophthalmol 2021; 138:660-670. [PMID: 32324211 DOI: 10.1001/jamaophthalmol.2020.1120] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Limbal stem cell transplant (LSCT) can be categorized as direct autologous limbal transplant (AULT), direct allogenic limbal transplant (ALLT), cultivated autologous limbal stem cells transplant (cAULT), and cultivated allogenic limbal stem cells transplant (cALLT). To our knowledge, there is no study directly comparing the outcomes and complications of these procedures. Objective To evaluate the outcomes of different LSCT procedures. Data Source We searched PubMed, EMBASE, Web of Science, and Cochrane without language filter for peer-reviewed articles about LSCT. The latest search was performed on June 30, 2019. Study Selection Clinical studies with the outcome of at least 20 eyes after LSCT were included. Animal studies and studies of other surgical interventions were excluded. Data Extraction and Synthesis Two reviewers independently abstracted the data from each study. Heterogeneity was evaluated with the I2 statistic, and a meta-analysis was performed using the random-effects model. Main Outcomes and Measures Outcome measures included the improvement of ocular surface, visual acuity (VA), and adverse events of recipient eyes and donor eyes. Results Forty studies (2202 eyes) with a mean (SD) follow-up of 31.3 (20.9) months met the inclusion criteria. The mean (SD) age of study participants was 38.4 (13.1) years, and men accounted for 74%. The number of eyes that underwent AULT, ALLT, cAULT, and cALLT were 505, 742, 771, and 184, respectively. Improvement of the ocular surface was achieved in 74.5% of all eyes, 85.7% of eyes after AULT (95% CI, 79.5%-90.3%), 84.7% after cAULT (95% CI, 77.2%-90.0%), 57.8% after ALLT (95% CI, 49.0%-66.1%), and 63.2% after cALLT (95% CI, 49.3%-75.2%). Autologous limbal transplantation resulted in a greater VA improvement rate (76%) than did the other 3 procedures (cAULT: 56.4%; ALLT: 52.3%; cALLT: 43.3%; all P < .001). The most common adverse events in all recipient eyes were recurrent/persistent epithelial erosion (10.5%; 95% CI, 7.2%-23.3%) and elevated intraocular pressure (intraocular pressure, 1.7%; 95% CI, 0.5%-7.8%). Patients who underwent ALLT had the highest rate of recurrent epithelial erosion (27.8%; 95% CI, 17.1%-41.9%) and intraocular pressure elevation (6.3%; 95% CI, 1.8%-19.4%). Conclusions and Relevance These findings suggest LSCT can improve or stabilize the corneal surface with a low rate of severe ocular complications and that autologous LSCT may have a higher success rate and fewer complications than allogenic LSCT.
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Affiliation(s)
- Qihua Le
- David Geffen School of Medicine, Stein Eye Institute, Cornea Division, University of California, Los Angeles.,Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Tulika Chauhan
- David Geffen School of Medicine, Stein Eye Institute, Cornea Division, University of California, Los Angeles.,Mahatma Gandhi Memorial Medical College, DAVV University, Indore, MP, India
| | - Madeline Yung
- David Geffen School of Medicine, Stein Eye Institute, Cornea Division, University of California, Los Angeles
| | - Chi-Hong Tseng
- David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
| | - Sophie X Deng
- David Geffen School of Medicine, Stein Eye Institute, Cornea Division, University of California, Los Angeles
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Saccu G, Menchise V, Giordano C, Delli Castelli D, Dastrù W, Pellicano R, Tolosano E, Van Pham P, Altruda F, Fagoonee S. Regenerative Approaches and Future Trends for the Treatment of Corneal Burn Injuries. J Clin Med 2021; 10:jcm10020317. [PMID: 33467167 PMCID: PMC7830803 DOI: 10.3390/jcm10020317] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/13/2022] Open
Abstract
Ocular chemical and thermal burns are frequent causes of hospitalization and require immediate interventions and care. Various surgical and pharmacological treatment strategies are employed according to damage severity. Controlling inflammation and neovascularization while promoting normal ocular surface anatomy and function restoration is the principal aim. In the most severe cases, when epithelial healing is severely affected, reconstruction of the ocular surface may be a valid option, which, however, requires expertise, adequate instruments, and qualified donors. Numerous endogenous and exogenous strategies have been considered for corneal repair. Among these, stem cells and their derivatives have offered numerous attractive possibilities in finding an effective way in stimulating corneal regeneration. Limbal epithelial stem cells and mesenchymal cells from the ocular tissue as well as from various sources have demonstrated their effectiveness in dampening neovascularization, scarring, and inflammation, while promoting epithelialization of the injured cornea. Moreover, a plethora of cytokines and growth factors, and extracellular vesicles, which constitute the secretome of these cells, work in concert to enhance wound healing. In this review, we provide an update on the recent potential therapeutic avenues and clinical applications of stem cells and their products in corneal regeneration after burn injury, as well as current imaging strategies for monitoring therapeutic efficacy and damage resolution.
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Affiliation(s)
- Gabriele Saccu
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
| | - Valeria Menchise
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, 10126 Turin, Italy
- Correspondence: (V.M.); (F.A.); (S.F.); Tel.: +39-0116706423 (S.F.)
| | - Cristina Giordano
- Ophthalmology Veterinary Practice, c.so Galileo Ferraris 121, 10126 Turin, Italy;
| | - Daniela Delli Castelli
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
| | - Walter Dastrù
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
| | | | - Emanuela Tolosano
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
| | - Phuc Van Pham
- Laboratory of Stem Cell Research and Application, and Stem Cell Institute, VNUHCM University of Science, Ho Chi Minh City 08000, Vietnam;
| | - Fiorella Altruda
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
- Correspondence: (V.M.); (F.A.); (S.F.); Tel.: +39-0116706423 (S.F.)
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, 10126 Turin, Italy
- Correspondence: (V.M.); (F.A.); (S.F.); Tel.: +39-0116706423 (S.F.)
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Arora R, Saran R, Jha V, Gotmare ND, Jain P. Immunocytochemistry of the ocular surface after different techniques of limbal stem cell transplantation for chronic chemical burns. Br J Ophthalmol 2020; 106:461-466. [PMID: 33328186 DOI: 10.1136/bjophthalmol-2020-317051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/18/2020] [Accepted: 11/28/2020] [Indexed: 11/04/2022]
Abstract
AIM To compare the immunocytochemistry (ICC) on impression cytology of corneal surface epithelium after simple limbal epithelial transplantation (SLET) and conjunctival-limbal autograft (CLAU). METHODS A prospective study of 20 patients above 1 year of age with chronic chemical burns, who underwent limbal stem cell transplantation (LSCT). They were divided equally in group A (SLET) and group B (CLAU). ICC was done for cytokeratin 3 (CK3) and cytokeratin 19 (CK19), preoperatively and postoperatively at 6 months. RESULTS Four cases were excluded due to inadequate cellularity in preoperative or postoperative samples. On ICC analysis, in the remaining 16 patients mean CK3 and CK19 positivity changed from 2.06%±1.73% and 83.56%±8.69% preoperatively to 70.62%±13.2% (p<0.0001) and 5.93%±4.17% (p<0.0001), respectively, at 6 months post LSCT. In group A (8 patients) mean CK3 and CK19 positivity of 2%±1.8% and 84.5%±8.4% preoperatively changed to 70%±13.8% (p<0.0001) and 6.25%±5.1% (p<0.0001) at 6 months respectively. While in group B (8 patients), it was 2.12%±1.7% and 82.62%±9.4% preoperatively and 71.25%±013.5% (p<0.0001) and 5.62%±3.2% (p<0.0001) at 6 months. There was no significant difference in expression of CK3 (p=0.084) and CK19 (p=0.744) post SLET or CLAU.Three patients with complete reversion had clear corneas at 6 months. CONCLUSION Reversion of the epithelium to corneal phenotype was documented post LSCT with no difference in expression of CK3 between the two procedures (SLET/CLAU).
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Affiliation(s)
- Ritu Arora
- Ophthalmology, Guru Nanak Eye Centre, New Delhi, Delhi, India
| | | | - Vikas Jha
- Ophthalmology, Guru Nanak Eye Centre, New Delhi, Delhi, India
| | | | - Parul Jain
- Ophthalmology, Guru Nanak Eye Centre, New Delhi, Delhi, India
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Kate A, Shanbhag SS, Goyal R, Basu S. Serial anterior segment optical coherence tomography post autologous simple limbal epithelial transplantation. BMJ Case Rep 2020; 13:13/12/e236692. [PMID: 33318273 PMCID: PMC7737076 DOI: 10.1136/bcr-2020-236692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 24-year-old young man presented to us with total limbal stem cell deficiency (LSCD) in the right eye 1 year post ocular chemical burn. The patient subsequently underwent limbal biopsy in the healthy contralateral eye and autologous simple limbal epithelial transplantation in the right eye. The patient was followed up with sequential imaging of the cornea with high-resolution anterior segment optical coherence tomography (HR-ASOCT) for 3 years. The serial HR-ASOCT imaging in the operated eye showed regeneration of the epithelium from the limbal transplant over the human amniotic membrane (hAM) with integration of the transplant within the cornea with subepithelial retention of the hAM. Over the long-term follow-up, thinning of the hAM and thickening of the epithelium was noted. At 3 years, the cornea maintained an intact epithelium with no signs of recurrence of LSCD.
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Affiliation(s)
- Anahita Kate
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S Shanbhag
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ritin Goyal
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India,Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Shanbhag SS, Tarini S, Kunapuli A, Basu S. Simultaneous surgical management of unilateral limbal stem cell deficiency and symblepharon post chemical burn. BMJ Case Rep 2020; 13:13/12/e237234. [PMID: 33298485 DOI: 10.1136/bcr-2020-237234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 6-year-old female child presented with severe acute ocular chemical burn in the right eye 2 days after injury with cement. She underwent removal of all foreign bodies from the ocular surface and amniotic membrane transplantation. Three months later, she developed unilateral total limbal stem cell deficiency (LSCD) with symblepharon in two quadrants. Three months after the acute injury, the patient underwent autologous simple limbal epithelial transplant in the right eye with one-clock hour of limbus harvested from the left eye. At the same sitting, she underwent symblepharon release in two quadrants of the right eye with conjunctival autograft harvested from the left eye followed by conjunctival graft suturing to the areas of bare sclera in the right eye. One year after surgery, the patient's visual acuity improved from counting fingers close to face preoperatively to 20/50 (uncorrected) with no recurrence of LSCD or symblepharon.
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Affiliation(s)
- Swapna S Shanbhag
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Shilpa Tarini
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anuradha Kunapuli
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India .,Brien Holden Eye Research Centre (BHERC), LV Prasad Eye Institute, Hyderabad, Telangana, India
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Panthier C, Bouvet M, Debellemaniere G, Gatinel D. Conjunctival limbal autografting (CLAU) combined with customised simple limbal epithelial transplantation (SLET) in a severe corneal chemical burn: Case report. Am J Ophthalmol Case Rep 2020; 20:100906. [PMID: 32984648 PMCID: PMC7495015 DOI: 10.1016/j.ajoc.2020.100906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 08/22/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose The most common cause of severe limbal stem cell deficiency (LSCD) is chemical injury. We report a case of severe unilateral alkali injury complicated by total LSCD, treated with customized Simple limbal epithelial transplantation (SLET) combined with conjunctival-limbal autografting (CLAU). Observation A 23-year-old female sustained a severe unilateral alkali chemical injury, resulting in total LSCD, treated with customized SLET combined with CLAU. We used two autologous limbal biopsies harvested from the fellow eye. One was used for CLAU and the second was split into multiple pieces, and was glued to bare stroma following resection of the corneal pannus. A stable ocular surface was achieved, and the donor eye remained healthy. Visual acuity improved from hand motion initially, to 20/20 over one year post-operatively. Conclusion and importance This case report demonstrates the efficacy and safety of customized SLET with supplemental CLAU to treat total LSCD in severe ocular burns.
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Affiliation(s)
- Christophe Panthier
- Department of Ophthalmology, Adolphe de Rothschild Foundation, Paris, France
- Corresponding author.
| | - Magalie Bouvet
- Department of Ophthalmology, University Hospital Centre of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
| | | | - Damien Gatinel
- Department of Ophthalmology, Adolphe de Rothschild Foundation, Paris, France
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Priyadarsini S, Whelchel A, Nicholas S, Sharif R, Riaz K, Karamichos D. Diabetic keratopathy: Insights and challenges. Surv Ophthalmol 2020; 65:513-529. [PMID: 32092364 PMCID: PMC8116932 DOI: 10.1016/j.survophthal.2020.02.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
Ocular complications from diabetes mellitus are common. Diabetic keratopathy, the most frequent clinical condition affecting the human cornea, is a potentially sight-threatening condition caused mostly by epithelial disturbances that are of clinical and research attention because of their severity. Diabetic keratopathy exhibits several clinical manifestations, including persistent corneal epithelial erosion, superficial punctate keratopathy, delayed epithelial regeneration, and decreased corneal sensitivity, that may lead to compromised visual acuity or permanent vision loss. The limited amount of clinical studies makes it difficult to fully understand the pathobiology of diabetic keratopathy. Effective therapeutic approaches are elusive. We summarize the clinical manifestations of diabetic keratopathy and discuss available treatments and up-to-date research studies in an attempt to provide a thorough overview of the disorder.
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Affiliation(s)
- S Priyadarsini
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - A Whelchel
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - S Nicholas
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - R Sharif
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - K Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - D Karamichos
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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