In-Situ Cultivation of Limbal Epithelial Stem Cells for the Treatment of Unilateral Limbal Stem Cell Deficiency following Ocular Surface Burns

Abstract

Purpose: : Autologous limbal stem cell transplantation is the standard of care for patients with unilateral corneal blindness following ocular surface burns. However, current surgical techniques are either risky for the donor eye (conjunctival-limbal autografting), or require sophisticated laboratory facilities (ex-vivo cultivated limbal epithelial transplantation). This study describes a novel surgical technique of limbal transplantation that combines the benefits of existing techniques, while avoiding their difficulties. Methods: : Six patients with unilateral and total limbal stem cell deficiency following ocular surface burns underwent a single staged procedure. A 2 x 2 mm strip of donor limbal tissue was obtained from the healthy eye and divided into eight to ten small pieces. After surgical preparation of the recipient ocular surface these tiny limbal transplants were distributed evenly over an amniotic membrane placed on the cornea. Results: : Following surgery, a completely epithelialized, avascular and stable corneal surface was seen in all recipient eyes by six weeks and this was maintained at a mean follow-up of 9.2±1.9 months. Visual acuity improved from worse than 20/200 in all recipient eyes prior to surgery, to 20/60 or better in 4 (66.6%) eyes, while none of the donor eyes developed any complications. Conclusions: : This technique requires less donor tissue than previously used for conventional autografting and does not need a specialist laboratory for cell expansion. Although long-term results are awaited, this simplified technique of limbal transplantation promises to be an easy and effective method of treating unilateral limbal stem cell deficiency following ocular surface burns.