Cultivated corneal epithelial stem cell transplantation in ocular surface disorders

Purpose: To investigate the outcome of cultivated corneal epithelial transp lantation for severe stem cell deficiencies using denuded amniotic membrane (AM) as a carrier. Design: Retrospective, noncomparative case series. Participants: Thirteen eyes of 11 patients were studied. These consisted of five eyes with acute Stevens-Johnson syndrome (SJS), two with chronic SJS, one with an acute chemical injury, two with chronic chemical injuries, two with ocular cicatricial pemphigoid, and one with drug-induced pseudopemphi goid. All of these eyes had total stem cell deficiencies. Main Outcome Measures: Adaptation of the cultivated corneal epithelium onto the host corneal surface was confirmed 48 hours after surgery. The reconst ruction of the ocular surface and visual acuity were measured. Methods: Corneal limbal epithelium from donor corneas was cultivated for 4 weeks on a denuded AM carrier, with 3T3 fibroblast coculture and air liftin g. The cultivated corneal epithelium showed four to five layers of stratifi cation and was well differentiated. After conjunctival tissue removal from the cornea up to 3 mm outside the limbus and subconjunctival tissue treatme nt with 0.04% mitomycin C, cultivated allocorneal epithelium, including the AM carrier, was transplanted onto the corneal surface up to the limbus. La mellar keratoplasty, using preserved donor graft without epithelium, was pe rformed simultaneously for five chronic-phase patients showing corneal stro mal scarring. Systemic immunosuppression was used to prevent allograft reje ction. Results: In all 13 eyes, the entire corneal surface, on which cultivated al locorneal epithelium had been placed, was free from epithelial defects 48 h ours after surgery, indicating complete survival of the transplanted cornea l epithelium. Visual acuity improved in all eyes after surgery, and 10 of t he 13 eyes were restored to good vision (postoperative visual acuity improv ed two or more lines) 6 months after the operation. During the follow-up pe riod (mean standard deviation, 11.2 +/- 1.3 months), the corneal surfaces w ere clear, although three eyes experienced epithelial rejection. Conclusions. Cultivated corneal epithelial transplantation using denuded AM as a carrier can be used for severe stem cell deficiencies. (C) 2001 by th e American Academy of Ophthalmology.