Abstract

SO.06.11

Special indications for bioengineered limbal stem cells

Fuchsluger T. A., Westekemper H., Pauklin M., Wettey F., Lonskowski D., Steuhl K. P., Meller D.
Center of Ophthalmology, University Hospital Essen

Objective: The main patient collective considered for tissue engineered limbal epithelial cells transplantations currently are chemical burn patients. Experiences and outcomes providing bioengineered limbal stem cells (HLEC) for deficiencies related to congenital aniridia keratopathy and for forniceal reconstructions are delivered.
Methods: 4 eyes suffering from congenital aniridia keratopathy, 2 eyes affected by distinct symblepharon were recruited. Another aniridia patient is awaiting early surgery. HLEC harvested from autologous biopsies or multi-organ donors were expanded on intact human amniotic membrane (hAM) utilizing autologous serum (AS). After laminar keratectomy and/or forniceal reconstruction the hAM with the expanded HLEC was transferred to the ocular surface. Postoperatively, patients received Botox-induced ptosis and were treated with AS eye drops. Allograft recipients also received Ciclosporin A. The main outcome measures were cultivation time, recurrence, post-operative bleeding, incidence of complications, motility restriction and establishment of lasting ocular surface integrity.
Results: In six eyes (52±16.1 [40-82] years) follow-up was 11.3±8.9 (1-21) months. The patients affected by symblepharon improved in visual acuity ³ two lines and show deep fornices. Eyes with congenital aniridia keratopathy reached functional ambulatory visual acuity (<20/200) befenitting from reduced glare sensitivity. All eyes showed a clear, smooth, and stable corneal ocular surface without signs of recurrence. Post-surgical complications were little postoperative bleeding and slight peripheric corneal scarring.
Conclusions: Bioengineered corneal epithelium cultivated on hAM offers a promising possibility to reconstruct the ocular surface in eyes affected by various demanding conjunctival and corneal entities. Long-term follow-up is necessary to conclude on whether the repopulation of the limbal epithelial stem cells, which is clinically apparent, is also effective in order to prevent late recurrences of the diseases.

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