Abstract

SA.20.07

Two-year results of cultivated autologous and allogeneic limbal epithelial grafting by limbal stem cell deficiency

Daniel Meller, Mikk Pauklin, Henrike Westekemper, Nina Niederdräing, Thomas Fuchsluger, Klaus-Peter Steuhl
Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen

Objective
To report the clinical outcome of on intact amniotic membrane expanded autologous and allogenic limbal epithelial cell transplantation for ocular surface reconstruction in limbal stem cell deficiency (LSCD).
Methods
Forty-four eyes of 38 patients (27 male and 11 female) with total (n=32) or partial (n=12) LSCD were treated by transplantation of autologous and allogenic limbal epithelial cells expanded on intact AM. The etiology of LSCD was chemical and thermal burns (n=22), pterygium (n=9), congenital aniridia (n=6), tumor excisison (n=2), perforating injury, mitomycin C induced LSCD, Epidermolysis bullosa, bilateral GVHD and chlamydial conjunctivitis (each n=1). Autologous donor tissue was used in 30 eyes and allogenic tissue in 14 eyes. Only eyes with a follow-up time of at least 9 months were included in the analysis. The main outcome measures were restoration of ocular surface integrity and improvement of visual acuity (VA).
Results
The mean follow-up time was 27.7±14.3 months. An entirely stable corneal surface was reconstructed in 30 eyes (68%). Visual acuity increased significantly in 30 (71%), was stable in 11 (25%) and decreased in two (4%) eyes. The mean VA increased significantly (p<0.0001) from preoperative 1.7±0.9 LogMAR to 0.9±0.7 LogMAR. The VA increased significantly after both autologous (p<0.0001) and allogeneic transplantation (p<0.005). Autologous transplantation had a two-fold lower risk of graft failure than allogeneic transplantation.
Conclusions
Transplantation of on intact AM cultivated limbal epithelium restores a stable corneal surface and results in a significant increase of visual acuity in most cases of LSCD. Autologous transplantation should be preferred, because of a lower risk of failure in comparison to allogeneic grafting which therefore requires a long-term administration of immunosuppressive agents.

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