Early results of ocular surface reconstruction in unilateral severe limbal stem cell deficiency using autologous cultured limbal and conjunctival stem cells

Abstract

Purpose: To report the interim results of cultured limbal and conjunctival stem cell transplantation in patients with severe unilateral limbal stem cell deficiency (LSCD). Methods: Twenty five patients with total LSCD, secondary to chemical burns, unresponsive to standard medical and surgical treatments were chosen for cultured stem cell transplantation. Limbal tissue of 2x2 mm was harvested from the healthy eye and cultured by explant technique on de-epithelialized human amniotic membrane and transplanted to the ocular surface of the diseased eye, after excision of pannus. Supplementation with autologous cultured conjunctival cells was done in 18 cases with severe conjunctival damage. The cases were followed up for a period of 1- 8 months. Results: The ocular surface stability and relief from symptoms was noted in all patients at 6 weeks follow-up. Of the 24 cases on regular follow-up, 18/24 (75 %) cases showed stable ocular surface at the last follow-up. Two of these cases underwent successful keratoplasty with good visual recovery. Two cases (8.3 %) failed with recurrence of vascularization. Supplementation with conjunctival cell cultures provided a healthy bed for limbal transplantation in all cases; with restoration of the entire surface in 17/18 cases. Conclusions: Cultured limbal cell transplantation is helpful in restoring ocular surface stability in most cases of limbal stem cell deficiency. In severe LSCD with associated damage to conjunctiva, simultaneous transplantation of cultured conjunctival cells is a novel method of restoring the entire ocular surface integrity.