Cultivated limbal epithelial transplantation (CLET) is a recently developedsurgical method to reconstruct the ocular surface in eyes with limbal dysfunction. The concept of the CLET is to produce a limbal epithelial sheet containing progenitor cells of the corneal epithelium, and then to transplant to the ocular surface following excision of cicatricial tissues. The method was first reported by Pellegrini et al in 1997, followed by several other investigators including our group. [1][2][3][4][5][6][7][8][9][10][11][12] In our previous report in 2002, the short-term outcomes of CLET were comparable with conventional limbal epithelial transplantation. 7 We found that the method did not produce excellent outcomes in patients with severe cicatricial ocular surface disorders such as Stevens-Johnson syndrome (SJS) and chemical/thermal burns of the cornea. 7 This may be due to the fact that many of the patients had risk factors for poor epithelialization such as decreased tear production, lid abnormalities, persistent inflammation. [13][14][15] It is not clear whether the relatively poor outcomes of our previous report can be improved by the modification of the epithelial sheet preparation. There are a variety of factors that may influence the quality of the epithelial sheet, which include; source of cells, preparation of the cells, types of substrates used, cultivation medium, the use of feeder cells, and culture conditions. Our group has made some modification of the cultivation/preparation methods including the use of feeder cells, cell suspension technique and air-lifting of the cell sheet.In order to investigate whether the modification resulted in improvement in surgical outcomes, we retrospectively studied the mid-term outcomes of CLET. The mid-term outcomes of CLET for chronic cicatricial ocular surface disorders were compared with the different cultivation methods. Also, other factors were analyzed to see if they influenced the results.
METHODS PatientsTwenty nine eyes of 27 patients that had CLET between June 1999 and November 2003 were retrospectively analyzed in this study. Patients consisted of 16 males and 11 females, with a mean age of 50.2 + 20.7 years (15-82 years). All eyes had total limbal dysfunction. Conjunctivalization was confirmed preoperatively by impression cytology in 10 of 27 eyes. Mean corrected visual acuity was counting fingers, and two-third of the eyes had less than 20/2000. Schirmer`s test was performed in 21 eyes and decreased tear secretion (Schirmer`s value < 5 mm) was noted in 12 eyes. As for preoperative complications, glaucoma, macular degeneration, and lid deformity were noted in 4, 1, and 3 eyes, respectively.