Artikel
Reconstruction of corneal ocular surface by ex-vivo expansion of limbal epithelial stem cells on intact amniotic membrane in limbal stem cell deficiency : Case reports
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Autoren
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K.-P. Steuhl
- Department of Ophthalmology, University Hospital Essen, Essen
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H. Wüstemeyer
- Department of Ophthalmology, University Hospital Essen, Essen
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E. E. Hernandez Galindo
- Department of Ophthalmology, University Hospital Essen, Essen
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D. Meller
- Department of Ophthalmology, University Hospital Essen, Essen
| Veröffentlicht: | 22. September 2004 |
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Gliederung
Text
Objective
Limbal stem cell deficiency (LSCD) can result from various ocular surface diseases. In order to restore vision and normal corneal surface in these diseases renewal of the limbal epithelial stem cell population is required. Recent advancements in cell biology have enabled the development of new models of tissue engineering as a tool for tissue replacement. First clinical experiences with the technique of Ex-vivo expansion of limbal epithelial stem cells are summarized
Methods
We performed ex-vivo expansion of limbal stem cells from a small limbal biopsy (1x2mm) of the patient's healthy fellow eye. Ex-vivo expansion was performed on intact AM using SHEM as culture media supplemented with autologous serum (5%). Two weeks later, following laminar keratectomy, the AM with the expanded limbal epithelial stem cells was placed on the corneal defect. A second AM was used as protective patch.
Results
Follow-up was 10 ± 4 months. Four patients (mean age 45 ± 29 years) underwent the autologous ex-vivo expansion and transplantation of limbal epithelial stem cells, which were expanded on intact amniotic membrane (AM). Three patients had a complete LSCD following chemical burn, whereas one patient had a partial LSCD caused by a recurrent and largely extended pterygium. At the present state of the follow-up all four patients show a clear, smooth, and stable corneal ocular surface without recurrence of stem cell deficiency. Post-surgical complications were bleeding underneath the AM in three cases, which resorbed uneventfully under local therapy. One patient showed a mild, probably contact lens induced proliferation of vessels at the limbus. Three patients showed an improvement of visual acuity of greater than three visual lines. One patient showed a stable visual acuity before and 6 months after surgery.
Conclusions
This method of autologous ex-vivo expansion of limbal stem cells offers the possibility to reconstruct the ocular surface in a variety of states causing limbal stem cell deficiency. Long-term follow-up is necessary to conclude on whether the repopulation of the limbal epithelial stem cells, which is clinically apparent, is also effective in order to prevent late recurrences of the disease.
