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Tutas Günaydın N, Barut Selver O. Pediatric limbal stem cell deficiency: An overview of a rarely studied pathology. Eur J Ophthalmol 2025; 35:821-833. [PMID: 39473431 DOI: 10.1177/11206721241291995] [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] [Indexed: 04/22/2025]
Abstract
The cornea is the outermost transparent layer of the eye, and the continuous renewal of the corneal epithelium is important for its transparency. This process is primarily facilitated by corneal stem cells, most of which are found at the limbus. However, any deterioration or damage in this region leads to corneal conjunctivalization and consequent limbal stem cell deficiency (LSCD), which compromises corneal transparency. LSCD is an important condition, especially in the pediatric population, as it can lead to corneal vascularization, opacity and ultimately loss of vision and subsequent amblyopia, unlike adults. Although pediatric LSCD is often due to chemical injuries, as in adults, it is also caused by conditions such as congenital aniridia, Steven Johnson Syndrome and various other immunological disorders. Appropriate and timely treatment in pediatric LSCD is of particular importance in preventing progression to amblyopia, unlike adults. Accurate staging of the disease is essential for the necessary medical and surgical treatment decision. While medical approaches are at the forefront to eliminate the causative agent and improve the ocular surface in reversible cases, it is essential to replace the limbal stem cells lost in advanced disease. For these replacement procedures, it is noteworthy that there is a tendency for minimally invasive methods compared to adults to avoid possible complications due to long life expectancy in children. In conclusion, although there are various reviews on limbal stem cell deficiency (LSCD) in adults, we believe that this review for childhood LSCD will make an important contribution to the literature, since the relevant literature currently reported for the pediatric population is limited.
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Affiliation(s)
- Nesrin Tutas Günaydın
- Department of Ophtalmology, Istanbul Arel University, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Ozlem Barut Selver
- Department of Ophthalmology, School of Medicine, Ege University, Izmir, Turkey
- Stem Cell Department, Graduate School of Health Sciences, Ege University, Izmir, Turkey
- Limbustem R&D Medical Products Ltd & Ocular Surface Research Laboratory, Ege University, Izmir, Turkey
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Korkmaz I, Palamar M, Timarci I, Egrilmez S, Yagci A, Barut Selver O. Limbal graft transplantation: a rare implementation in pediatric limbal stem cell deficiency. Int Ophthalmol 2024; 44:337. [PMID: 39093517 DOI: 10.1007/s10792-024-03269-5] [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: 02/24/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE To evaluate limbal graft transplantation success in pediatric patients with chemical injury-induced limbal stem cell deficiency (LSCD) using the 'LSCD Working Group' staging system. METHODS Medical records of 11 eyes of 11 children who underwent limbal graft transplantation (limbal autograft/limbal allograft) were included. Surgical success was defined as improvement in the post-operative 1st year LSCD stage. RESULTS The mean age was 12 ± 5 (4-17) years. Causative agent was alkaline in 4(36.4%) and acid in 3(27.2%) patients. Limbal autograft was performed in 9 (81.8%) eyes with unilateral LSCD, and allograft transplantation was performed in 2 (18.2%) eyes with bilateral LSCD. The mean follow-up time was 33.89 ± 30.73 (12-102.33) months. The overall limbal graft transplantation success rate was 72.7%. Among 9 patients who receive limbal autograft, 8 had improvement in post-operative LSCD stage, 1 had stable LSCD stage. Of the 2 patients who receive limbal allograft, post-operative LSCD stage remained the same in 1 and worsened in 1 patient. The mean time between injury and the surgery was 30.47 ± 30.08 (7-108.47) months. Penetrating keratoplasty was performed in 3 (27.2%) of 11 patients following limbal graft transplantation. CONCLUSION Management of LSCD in children is challenging and appears to be somewhat different from that of adults. Limited data in the literature indicate that cultivated or simple limbal epithelial transplantations (CLET/SLET) are primarily preferred in children. Although the tendency to take small tissue from the healthy eye is noteworthy, conventional limbal allograft and autograft transplantations also show promising results without any further complications in at least 1 year follow-up period.
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Affiliation(s)
- Ilayda Korkmaz
- Department of Ophthalmology, Ege University Medical Faculty Hospital, 35100, Izmir, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Ege University Medical Faculty Hospital, 35100, Izmir, Turkey
| | - Ilgin Timarci
- Department of Public Health, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Sait Egrilmez
- Department of Ophthalmology, Ege University Medical Faculty Hospital, 35100, Izmir, Turkey
| | - Ayse Yagci
- Department of Ophthalmology, Ege University Medical Faculty Hospital, 35100, Izmir, Turkey
| | - Ozlem Barut Selver
- Department of Ophthalmology, Ege University Medical Faculty Hospital, 35100, Izmir, Turkey.
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Holland EJ, Cheung AY, Djalilian AR, Farid M, Mannis MJ. Why Are Corneal Specialists Resistant to Treating Patients Who Have Severe Ocular Surface Disease With Limbal Stem Cell Deficiency? Cornea 2023; 42:1063-1068. [PMID: 37535943 DOI: 10.1097/ico.0000000000003322] [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: 10/27/2022] [Accepted: 05/05/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE To highlight the paucity of surgeons performing ocular surface stem cell transplantation with systemic immunosuppression (OSSTx with SI) for limbal stem cell deficiency (LSCD) patients, suboptimal treatments for LSCD, and obstacles to adoption. METHODS A review of the Eye Bank Association of America annual reports and the authors' case volume for OSSTx with SI was performed. Examination of the published literature on corneal surgeries, especially for LSCD, was completed. These findings were combined with our clinical observations to develop this editorial. RESULTS Despite techniques and protocols for OSSTx with SI published more than 30 years ago for the treatment of severe bilateral LSCD, only a small number of corneal specialists have adopted these techniques. There is a paucity of attention to this population of patients, with minimal publications to advance this area of our field. We are too often referred patients with LSCD and severe ocular surface disease that have had suboptimal treatments such as penetrating keratoplasties or primary keratoprostheses. Hesitancy for adopting OSSTx with SI is likely due to a lack of exposure to these procedures during training and fear of systemic immunosuppression. Corneal surgeons are likely unaware of the safety of systemic immunosuppression with appropriate monitoring especially when comanaging these patients with an organ transplant specialist. CONCLUSION There is a large unmet need for the treatment of corneal blindness secondary to conjunctival and LSCD. For the vast majority of patients, OSSTx should be the first surgical choice to treat these eyes. We hope major ophthalmology centers will meet this need by building programs, and groups of corneal surgeons should collaborate to create regional centers to make this treatment more accessible to help this population.
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Affiliation(s)
- Edward J Holland
- Cincinnati Eye Institute/University of Cincinnati, Cincinnati, OH
| | | | - Ali R Djalilian
- The University of Illinois, College of Medicine, Chicago, IL
| | - Marjan Farid
- Gavin Herbert Eye Institute, UC Irvine, Irvine, CA; and
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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: 0.5] [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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Giachos I, Angelidis CD, Doumazos S, Tzavara C, Palioura S. Outcomes of Combined Penetrating Keratoplasty and Limbal Stem Cell Transplantation: A Meta-Analysis on Simultaneous Versus Sequential Surgery. Cornea 2023; 42:787-796. [PMID: 36853592 DOI: 10.1097/ico.0000000000003261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE The objective of this study is to perform a systematic review and meta-analysis of the published studies on limbal stem cell transplantation (LSCT) combined with penetrating keratoplasty (PK) performed either simultaneously or sequentially. METHODS An extensive search was conducted in the MEDLINE and Google Scholar databases. Prospective and retrospective trials and case series reporting on the outcomes of LSCT with PK were included. Primary outcomes were the stability of the ocular surface and the rejection and/or failure of the corneal graft. RESULTS A total of 209 eyes from 13 studies were included in the simultaneous group and 489 eyes from 33 studies in the sequential group. Ocular surface stability was 88% [95% confidence interval (CI), 79%-96%] for sequential cases and 64% (95% CI, 43%-82%) for simultaneous cases ( P = 0.001). The graft failure rate was 15% (95% CI, 6%-26%) for sequential cases and 44% (95% CI, 31%-58%) for simultaneous cases ( P < 0.001). For cases performed sequentially, subgroup analysis revealed a stable ocular surface in 97% (95% CI, 91%-100%) of autograft cases and 63% (95% CI, 45%-80%) of allograft cases ( P < 0.001). The graft failure rate in sequential cases was 7% (95% CI, 0%-18%) for autografts and 34% (95% CI, 18%-52%) for allografts ( P < 0.001). CONCLUSIONS Sequential LSCT followed by PK demonstrated superior results in terms of ocular surface stability and graft retention compared with simultaneous LSCT and PK. Limbal stem cells of autologous origin fare better than allogeneic ones in sequential cases.
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Affiliation(s)
- Ioannis Giachos
- First Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Constantine D Angelidis
- First Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Spyros Doumazos
- First Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Chara Tzavara
- Department of Biostatistics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotiria Palioura
- Athens Eye Experts, Athens, Greece; and
- Department of Ophthalmology, University of Cyprus Medical School, Nicosia, Cyprus
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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: 1] [Impact Index Per Article: 0.3] [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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Masood F, Chang JH, Akbar A, Song A, Hu WY, Azar DT, Rosenblatt MI. Therapeutic Strategies for Restoring Perturbed Corneal Epithelial Homeostasis in Limbal Stem Cell Deficiency: Current Trends and Future Directions. Cells 2022; 11:3247. [PMID: 36291115 PMCID: PMC9600167 DOI: 10.3390/cells11203247] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 02/03/2023] Open
Abstract
Limbal stem cells constitute an important cell population required for regeneration of the corneal epithelium. If insults to limbal stem cells or their niche are sufficiently severe, a disease known as limbal stem cell deficiency occurs. In the absence of functioning limbal stem cells, vision-compromising conjunctivalization of the corneal epithelium occurs, leading to opacification, inflammation, neovascularization, and chronic scarring. Limbal stem cell transplantation is the standard treatment for unilateral cases of limbal stem cell deficiency, but bilateral cases require allogeneic transplantation. Herein we review the current therapeutic utilization of limbal stem cells. We also describe several limbal stem cell markers that impact their phenotype and function and discuss the possibility of modulating limbal stem cells and other sources of stem cells to facilitate the development of novel therapeutic interventions. We finally consider several hurdles for widespread adoption of these proposed methodologies and discuss how they can be overcome to realize vision-restoring interventions.
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Affiliation(s)
- Faisal Masood
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Jin-Hong Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Anosh Akbar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Amy Song
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Wen-Yang Hu
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Dimitri T. Azar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Mark I. Rosenblatt
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
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Krysik K, Miklaszewski P, Dobrowolski D, Lyssek-Boroń A, Grabarek BO, Wylęgała E. Ocular Surface Preparation Before Keratoprosthesis Implantation. Ophthalmol Ther 2022; 11:249-259. [PMID: 34811639 PMCID: PMC8770772 DOI: 10.1007/s40123-021-00420-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the surgical treatment results for conjunctival limbal autograft (CLAU) and keratolimbal allograft (KLAL) in various types of limbal stem cell deficiency (LSCD) etiologies performed in order to achieve a stable ocular surface prior to KPro implantation. METHODS We analyzed the outcomes of the surgical treatment of 43 eyes of 39 patients with LSCD as an initial treatment preparing patients' ocular surface for KPro implantation. The most common causes were ocular trauma (50.7%), mainly alkali burns (77%); autoimmune causes, mainly ocular cicatricial pemphigoid (OCP; 17.4%); infection (15.9%) including Lyell's syndrome/Stevens-Johnson syndrome (LS/SJS; 16%). In all 17 eyes operated on with CLAU, this procedure was performed once. Similarly, one uncomplicated KLAL procedure in one eye was performed in 10 women and 19 men. In another one woman and three men, KLAL was performed in both eyes. In one man with Lyell's syndrome, the KLAL operation was performed three times in one eye. Follow-up was at least 12 months. RESULTS Visual acuity (VA) improved in 17 eyes (31%) and remained unchanged in 38 eyes (69%). VA improved from light perception to hand movements in three eyes (16%) from the CLAU group of patients and eight eyes (15%) from the KLAL group; VA improved from hand movements to finger counting in two eyes (12%) post CLAU and two eyes (4%) post KLAL operation. The most common complication of surgical treatment was persistent epithelial defect that was refractory to medical treatment in 32 eyes (58%), 5 eyes post CLAU and 27 post KLAL. Corneal conjunctivalization (19%) and neovascularization (29%) were present on the corneal edge of the graft. Symblephara recurred within 3 months in nine eyes (17.3%) after KLAL, including four eyes that had been chemically burned and five eyes with LS/SJS. DISCUSSION Pretreatment with CLAU or KLAL procedures in severely damaged ocular surfaces allows the ocular surface to be prepared for safe KPro implantation with sufficient tissue surroundings with less conjunctivalization and deeper conjunctival fornices.
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Affiliation(s)
- Katarzyna Krysik
- Department of Ophthalmology, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800, Zabrze, Poland
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital in Sosnowiec, 41-200, Sosnowiec, Poland
| | - Piotr Miklaszewski
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital in Sosnowiec, 41-200, Sosnowiec, Poland
| | - Dariusz Dobrowolski
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital in Sosnowiec, 41-200, Sosnowiec, Poland
- Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia in Katowice, 40-760, Katowice, Poland
| | - Anita Lyssek-Boroń
- Department of Ophthalmology, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800, Zabrze, Poland
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital in Sosnowiec, 41-200, Sosnowiec, Poland
| | - Beniamin O Grabarek
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800, Zabrze, Poland.
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia in Katowice, 40-760, Katowice, Poland
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Evaluation of Clinical and Histological Outcomes of Adipose-Derived Mesenchymal Stem Cells in a Rabbit Corneal Alkali Burn Model. Stem Cells Int 2021; 2021:6610023. [PMID: 33763139 PMCID: PMC7964115 DOI: 10.1155/2021/6610023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/30/2021] [Accepted: 02/14/2021] [Indexed: 11/18/2022] Open
Abstract
To assess effects of adipose-derived mesenchymal stem cells (AMSCs) in corneal alkali injuries in an experimental animal model. Twenty white New Zealand rabbits were included in the study. The animal models were randomly divided into 2 groups. Rabbits in the AMSC group (n = 10) received an intrastromal, a subconjunctival injection, and topical instillation of 0.5 ml totally of phosphate-buffered saline (PBS) containing 2 × 106 AMSCs. In the control group (n = 10), rabbits received only 0.5 ml of PBS using the same methods. A masked investigator measured the corneal sensation, anterior chamber Inflammation (ACI), and conjunctival congestion. Additionally, a blind histological and immunohistochemical evaluation was made. In the AMSC group, the central corneal sensation was increased whereas ACI and conjunctival congestion were reduced compared to the control group in the 28 days of follow-up (p < 0.05). A statistically significant difference (p < 0.05) was noted between the two groups as recorded in the above parameters. Histological analysis showed that pathological vascularization was markedly reduced in the AMSC group which was consistent with the absence of factor VIII in the immunohistochemistry sections. There is a trend towards improved clinical outcomes including corneal sensation as well as acceleration in the restoration of normal corneal architecture in corneal alkali burns treated with AMSCs, results that support the need for further research in the field.
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