Abstract
Purpose
As a treatment to replace regenerative medicine to treat limbal stem cell deficiency (LSCD), we performed 4 consecutive cases of autologous transplantation of conjunctival explants by modifying simple limbal epithelial transplantation (SLET).
Study design
Single-center case series.
Methods
Four patients with LSCD were enrolled in this study. After resection of scar tissue with neovascularization from the ocular surface, human amniotic membrane (AM) was placed over the bare ocular surface. The bulbar conjunctiva of the operated eye was dissected at the temporal superior fornix, divided into small pieces, and transplanted onto AM with fibrin glue. Keratoplasty was performed simultaneously or few months after surgery.
Results
Epithelialization was achieved in all patients. Best-corrected visual acuity was improved in all patients.
Conclusion
This is the first report of ocular surface reconstruction using autologous conjunctival epithelial transplants from the affected eye. Transplantation by modifying SLET effectively restored a clear corneal surface with minimal neovascularization in 4 patients with LSCD. Autologous conjunctival transplants combined with AM transplantation could be a practical option for treating bilateral LSCD in patients without symblepharon or severe keratinization.
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References
Liang L, Sheha H, Li J, Tseng SC. Limbal stem cell transplantation: new progresses and challenges. Eye. 2009;23:1946–53.
Koizumi N, Inatomi T, Suzuki T, Sotozono C, Kinoshita S. Cultivated corneal epithelial stem cell transplantation in ocular surface disorders. Ophthalmology. 2001;108:1569–74.
Nishida K, Yamato M, Hayashida Y, Watanabe K, Yamamoto K, Adachi E, et al. Corneal reconstruction with tissue-engineered cell sheets composed of autologous oral mucosal epithelium. N Engl J Med. 2004;351:1187–96.
Sangwan VS, Basu S, MacNeil S, Balasubramanian D. Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency. Br J Ophthalmol. 2012;96:931–4.
Basu S, Sureka SP, Shanbhag SS, Kethiri AR, Singh V, Sangwan VS. Simple limbal epithelial transplantation: long-term clinical outcomes in 125 cases of unilateral chronic ocular surface burns. Ophthalmology. 2016;123:1000–10.
Borroni D, Wowra B, Romano V, Boyadzhieva M, Ponzin D, Ferrari S, et al. Simple limbal epithelial transplantation: a review on current approach and future directions. Surv Ophthalmol. 2018;63:869–74.
Tanioka H, Kawasaki S, Yamasaki K, Ang LP, Koizumi N, Nakamura T, et al. Establishment of a cultivated human conjunctival epithelium as an alternative tissue source for autologous corneal epithelial transplantation. Investig Ophthalmol Vis Sci. 2006;47:3820–7.
Ono K, Yokoo S, Mimura T, Usui T, Miyata K, Araie M, et al. Autologous transplantation of conjunctival epithelial cells cultured on amniotic membrane in a rabbit model. Mol Vis. 2007;13:1138–43.
Usui T, Nakagawa S, Yokoo S, Mimura T, Yamagami S, Amano S. Bilateral limbal stem cell deficiency with chromosomal translocation of 3p and 9p. Jpn J Ophthalmol. 2010;54:357–8.
Sotozono C, Inatomi T, Nakamura T, Koizumi N, Yokoi N, Ueta M, et al. Cultivated oral mucosal epithelial transplantation for persistent epithelial defect in severe ocular surface diseases with acute inflammatory activity. Acta Ophthalmol. 2014;92:e447–53.
Nakamura T, Takeda K, Inatomi T, Sotozono C, Kinoshita S. Long-term results of autologous cultivated oral mucosal epithelial transplantation in the scar phase of severe ocular surface disorders. Br J Ophthalmol. 2011;95(942–6):12.
Moyer PD, Kaufman AH, Zhang Z, Kao CW, Spaulding AG, Kao WW. Conjunctival epithelial cells can resurface denuded cornea, but do not transdifferentiate to express cornea-specific keratin 12 following removal of limbal epithelium in mouse. Differentiation. 1996;60:31–8.
Cho BJ, Djalilian AR, Obritsch WF, Matteson DM, Chan CC, Holland EJ. Conjunctival epithelial cells cultured on human amniotic membrane fail to transdifferentiate into corneal epithelial-type cells. Cornea. 1999;18:216–24.
Kawasaki S, Tanioka H, Yamasaki K, Yokoi N, Komuro A, Kinoshita S. Clusters of corneal epithelial cells reside ectopically in human conjunctival epithelium. Investig Ophthalmol Vis Sci. 2006;47:1359–67.
Lavker RM, Tseng SC, Sun TT. Corneal epithelial stem cells at the limbus: looking at some old problems from a new angle. Exp Eye Res. 2004;78:433–46.
Eslani M, Baradaran-Rafii A, Ahmad S. Cultivated limbal and oral mucosal epithelial transplantation. Semin Ophthalmol. 2012;27:80–93.
Silber PC, Ricardo JR, Cristovam PC, Hazarbassanov RM, Dreyfuss JL, Gomes JA. Conjunctival epithelial cells cultivated ex vivo from patients with total limbal stem cell deficiency. Eur J Ophthalmol. 2015;25:60–4.
Thoft RA. Conjunctival transplantation. Arch Ophthalmol. 1977;95:1425–7.
Thoft RA. Conjunctival transplantation as an alternative to keratoplasty. Ophthalmology. 1979;86:1084–92.
Jirsova K, Jones GLA. Amniotic membrane in ophthalmology: properties, preparation, storage and indications for grafting-a review. Cell Tissue Bank. 2017;18:193–204.
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Sakimoto, T., Sakimoto, A. & Yamagami, S. Autologous transplantation of conjunctiva by modifying simple limbal epithelial transplantation for limbal stem cell deficiency. Jpn J Ophthalmol 64, 54–61 (2020). https://doi.org/10.1007/s10384-019-00701-7
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DOI: https://doi.org/10.1007/s10384-019-00701-7