Autologous transplantation of conjunctiva by modifying simple limbal epithelial transplantation for limbal stem cell deficiency

Sakimoto, Tohru; Sakimoto, Akira; Yamagami, Satoru

doi:10.1007/s10384-019-00701-7

Cited by 10 publications

(4 citation statements)

References 19 publications

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“…The amniotic membrane is then covered with a contact lens. Four patients with LSCD originating from different causes underwent this surgical procedure and showed increased visual acuity and stable ocular surfaces [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

ALT (allogeneic limbal transplantation): a new surgical technique for limbal stem cell deficiency

et al. 2022

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Purpose Limbal stem cell deficiency (LSCD) is a rare but extremely relevant disease of the eye. LSCD patients often require a variety of surgical procedures, including keratoplasty in some cases. However, the outcome of these surgeries, including opacification and revascularization, is often frustrating due to LSCD relapse. Methods We developed a new surgical technique for the treatment of LSCD in which partial allogenic limbal transplantation (ALT) is carried out as part of penetrating keratoplasty (PK). After the PK, 1–8 slices from the limbal tissue of the donor graft are prepared and placed under the double running sutures attaching the corneal graft. This procedure was performed on 14 patients with LSCD, caused by severe ocular burn in 5 cases and by infection in 9. Between one and eight limbal transplants were used depending on the extension of the LSCD. Results All 14 patients showed stable or increased visual acuity after the ALT surgery compared to their preoperative visual acuity. All of the grafts were integrated into the superficial corneal layers without progression of corneal vascularization beyond the limbal grafts. The median follow-up period was 12 months on average. Conclusion The ALT method seems to be a promising surgical procedure for the treatment of patients with LSCD. It can be properly carried out in the context of keratoplasty and does not require a separate donor tissue. The ALT grafts may offer the possibility of constructing a new limbal region, resulting in stable or even increased visual acuity and the absence of corneal vascularization.

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Section: Discussionmentioning

confidence: 99%

ALT (allogeneic limbal transplantation): a new surgical technique for limbal stem cell deficiency

et al. 2022

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“…Our data indicate that intrinsic homeostatic reparative programs are initiated but may be ineffective in the long term due to the severe pathology that persists ( Figure 7 ). Transdifferentiation may also explain why there have been numerous reports of successful outcomes in patients and animals with LSCD that received conjunctival grafts ( Ang et al., 2010 ; Di Girolamo et al., 2009 ; Ono et al., 2007 ; Sakimoto et al., 2020 ; Thoft, 1977 ).…”

Section: Discussionmentioning

confidence: 99%

Plasticity of ocular surface epithelia: Using a murine model of limbal stem cell deficiency to delineate metaplasia and transdifferentiation

Park¹,

Zhang²,

Pandžić

et al. 2022

Stem Cell Reports

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“…We chose only partial and mild irregular epithelium covering the pupil as an indication for superficial keratectomy, because we think the existence of highly proliferative normal LSCs is essential for successful clinical results. Corneas with insufficient numbers of LSCs require auto- or allo-cell grafts involving stem cells such as LSCs, 6 , 7 , 8 , 9 , 10 , 11 conjunctival epithelium, 12 and oral mucosal epithelium 13 , 14 , . 15 These severe cases are a contra-indication for our technique.…”

Section: Discussionmentioning

confidence: 99%

“…3 , 4 In patients with LSC disease, the epithelium has an irregular appearance, 5 which sometimes reaches the center of the cornea and reduces visual acuity. Some severe cases with total LSC deficiency may require stem-cell transplantation of autologous 6 , 7 , 8 , 9 and cultured sheet 10 , 11 using limbal epithelium, conjunctivae, 12 and oral mucosal epithelium. 13 , 14 , 15 , 16 In partial LSC deficiency corneas, which are covered with vascular and conjunctival fibroblasts, the combination therapy with superficial keratectomy and amniotic membrane transplantation has been recommended to rebuild the ocular surface conditions.…”

Section: Introductionmentioning

confidence: 99%

Effects of corneal epithelial superficial keratectomy in patients with focal limbal stem cell disease

Inamochi

Miyai

Usui

et al. 2022

American Journal of Ophthalmology Case Reports

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Purpose Irregular corneal epithelium in limbal stem cell disease can cause visual acuity to deteriorate substantially when it reaches the pupil. In this case series, we assessed the effectiveness of simple corneal epithelial superficial keratectomy in improving visual acuity in patients with irregular corneal epithelium in focal limbal stem cell disease covering the visual axis. Observations We performed simple corneal epithelial superficial keratectomy in four patients (five eyes) with irregular corneal epithelium covering the visual axis. The main outcome measures were best-corrected visual acuity, slit lamp findings with fluorescein staining, anterior segment optical coherence tomography and histopathology. In all five eyes, slit lamp findings showed uneven fluorescein staining in a spiral pattern, with impaired corneal epithelial smoothness and visual disturbance. We removed the irregular epithelium in all five eyes. Visual acuity in all the eyes was improved immediately after surgery, and good visual acuity and stable epithelium were maintained for the duration of the observation periods. Hematoxylin and eosin staining showed, normal squamous and columnar epithelial cells. Goblet cells were not detected. Conclusionsand Importance Corneal epithelial superficial keratectomy can lead to a pathological diagnosis by examining the removed epithelial tissues, and result in excellent therapeutic outcomes in focal limbal stem cell disease reaching the pupil.

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Autologous transplantation of conjunctiva by modifying simple limbal epithelial transplantation for limbal stem cell deficiency

Cited by 10 publications

References 19 publications

ALT (allogeneic limbal transplantation): a new surgical technique for limbal stem cell deficiency

ALT (allogeneic limbal transplantation): a new surgical technique for limbal stem cell deficiency

Plasticity of ocular surface epithelia: Using a murine model of limbal stem cell deficiency to delineate metaplasia and transdifferentiation

Effects of corneal epithelial superficial keratectomy in patients with focal limbal stem cell disease

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