Efficacy of cultivated corneal epithelial stem cells for ocular surface reconstruction

Abstract

Purpose

To investigate the clinical outcomes of cultivated corneal limbal epithelial transplantation (CLET) using human amniotic membrane for corneal limbal stem-cell deficiency.

Methods

Prospective, noncomparative case series. Eighteen patients (19 eyes) with severe ocular surface diseases were chosen to undergo CLET using human amniotic membrane. Twelve eyes received auto-CLET, and seven eyes received allo-CLET. Clinical outcomes of corneal surface epithelialization, conjunctivalization, inflammation, visual acuity, graft status, and complications were observed.

Results

Corneal epithelium cultivated on amniotic membrane (two to four layers) was positive for molecular markers p63, ABCG2, CK3, and CK12. The mean patient age was 44.7 ± 15.2 years. A successful clinical outcome, defined as corneal epithelialization without central conjunctivalization or severe inflammation, was obtained in 14 (73.7%) of 19 eyes (mean follow-up 26.1 ± 13.5 months; range 6–47). A histopathologic success, defined as absence of goblet cells at the central cornea, was achieved in 12 (63.2%) eyes. Clinical failures occurred in five (26.3%) of 19 eyes, and histopathologic failures occurred in seven (36.8%) of 19 eyes. Survival analysis at 1 year showed that the clinical success rate was 77.9% and the pathological success rate was 72.3%. Fourteen of 19 (73.7%) eyes had visual acuity improvements after CLET. Six cases underwent penetrating keratoplasty; five of these grafts remained clear after 20.4 ± 6.9 months (range, 12–31) of follow-up. Complications included infectious keratitis (three cases) and recurrent symblepharon (one case). All complicated cases had lid abnormalities. Factors affecting the final clinical outcomes were lid abnormalities, abnormal corneal stromal beds, and complications.

Conclusion

CLET can successfully restore ocular surface damage in most cases with corneal limbal stem cell deficiency.

Keywords:

• limbal deficiency
• limbal transplantation
• corneal epithelial stem-cell transplantation
• cultivated corneal epithelial stem cells

Acknowledgments

This study was supported by Mahidol University. We are grateful to Assistant Professor Chulaluk Komoltri, Dr PH (Biostatistics), and Pimrapat Tengtrakulcharoen, MBH, from the Office for Research and Development, for their assistance with statistical analysis, and to Mathuwan Srikong from the Medical Education Technology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, for preparing the figures.

Disclosure

The authors have no proprietary or commercial interest in any materials or products discussed in this article.