Outcomes and DNA analysis of ex vivo expanded stem cell allograft for ocular surface reconstruction

Daya, S., Watson, A., Sharpe, J.R., Giledi, O., Rowe, A., Martin, R. and JAMES, S.Elizabeth (2005) Outcomes and DNA analysis of ex vivo expanded stem cell allograft for ocular surface reconstruction Ophthalmology, 112 (3). pp. 470-477. ISSN 0161-6420

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Abstract

Purpose: To investigate the outcome of a new technique of ex vivo expanded stem cell allograft for limbal stem cell deficiency (LSCD), and to characterize the ocular surface genotype after surgery. Design: Retrospective noncomparative case series. Participants: Ten eyes of 10 patients with profound LSCD arising from ectodermal dysplasia (3 eyes), Stevens–Johnson syndrome (3 eyes), chemical injury (2 eyes), thermal injury (1 eye), and rosacea blepharoconjunctivitis (1 eye). Intervention: Allogeneic corneal limbal stem cells were cultured on plastic and transplanted to the recipient eye after removal of conjunctival pannus. Amniotic membrane was applied in a bandage capacity. The procedure was combined with other reconstructive surgery in 2 cases. Nine patients received systemic cyclosporin A immunosuppression, and the DNA genotype was investigated with surface impression cytology. Main outcome measures: Parameters of LSCD, including vascularization, conjunctivalization, inflammation, epithelial defect, photophobia, and pain. Results: The mean follow-up period was 28 months (range, 12–50). Seven of 10 eyes (70%) had improved parameters of LSCD at final follow-up and were considered successes. Four (40%) had improved visual acuity, including 3 having had further procedures for visual rehabilitation. Three patients failed to improve—1 with a thermal burn and lid deformity, 1 with Stevens–Johnson syndrome and severe dry eye, and 1 with ectodermal dysplasia who developed an epithelial defect at 26 months. DNA analysis of the first 7 cases showed no ex vivo donor stem cell DNA present beyond 9 months. Conclusions: Ex vivo expanded stem cell allograft is a useful technique for restoring the ocular surface in profound LSCD. The absence of donor DNA beyond 9 months suggests that ongoing immunosuppression may be unnecessary and raises questions regarding the origin of the host corneal epithelium.

Item Type: Journal article
Subjects: C000 Biological and Biomedical Sciences
C000 Biological and Biomedical Sciences > C700 Molecular Biology, Biophysics and Biochemistry
B000 Health Professions > B900 Others in Health Professions > B970 Ophthalmics
B000 Health Professions
DOI (a stable link to the resource): 10.1016/j.ophtha.2004.09.023
Faculties: Faculty of Science and Engineering > School of Pharmacy and Biomolecular Sciences > Biomedical Materials
Depositing User: Converis
Date Deposited: 08 Nov 2007
Last Modified: 28 Mar 2013 03:00
URI: http://eprints.brighton.ac.uk/id/eprint/2589

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