İsmet Durak, Özlem Barut Selver, Esra Erdal, İmge Kunter, Zeynep Özbek Söylemezoğlu, Jose Mario Wolosin
Purpose: To evaluate the 1-year follow-up results of cultivated limbal epithelial cell (CLEC) transplantation in unilateral limbal stem cell deficiency (LSCD).
Material and method: One-year follow-up results of five unilateral LSCD patients who had undergone CLEC transplantation were evaluated. Parameters for this evaluation were: fluorescein staining of ocular surface, corneal vascularization and status of epithelium with slit lamp, and visual acuity. 1.5-mm limbal biopsy was performed from the superior limbus of the healthy eyes, broke into two equal pieces, expanded on human amniotic membrane (hAM) and inserts for 14 days until getting 20 mm in size. CLECs on hAMs were used directly, and cells on inserts were used after detachment procedure. The symblepharon and pannus tissues were removed, superficial keratectomy was performed. CLEC on hAMs were transplanted with the epithelial side up onto the bare corneal stroma, sutured to the conjunctiva with 10-0 nylon sutures. Free CLEC layer from insert was placed on hAM as a second layer, additional hAM was used as a protective layer all over other tissues.
Results: Median age was 44.4 years (14-71). The etiology was chemical burn in all patients. Median duration of symptoms was 10 years (2-18), median follow-up period was 12.6 (12-12.5) months. Preoperative best corrected visual acuities (BCVA) were light perception in three patients, counting fingers at 50 cm in one patient and 3/10 in one patient. Visions were improved in all patients. Postoperative BCVA 12 months after the surgery were between counting fingers at 3 meters to 6/10. There was a temporary hemorrhage between the two layers of hAMs in one patient at the early postoperative period. Peripheral corneal vascularization has occurred in three patients, in patient corneal vascularization has reached to the paracentral area.
Discussion: CLEC transplantation is an efficient treatment option for unilateral LSCD in mid-long term.
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