Журнал исследований и терапии стволовых клеток

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Outcome of Corneal Limbal Stem Cell Transplant in the Treatment of Partial and Total Limbal Stem Cell Deficiency - A Middle East Experience

Ammar M. Al-Mahmood, Samar A. Al-Swailem, Abdullah A. Al-Assiri, Ghada Y. Al Bin Ali and Sabah S. Jastaneiah

Aim: To evaluate the outcomes of Conjunctival Limbal Autograft (CLAU) and Conjunctival Limbal Allograft (CLAL) transplants for the treatment of partial or total Limbal Stem Cell Deficiency (LSCD). Methods: Retrospective, cohort study. All eyes treated with limbal stem cell transplant (LSCT) that had 1 year follow-up or more were included. Visual success was measured by improvement in VA post operatively. Surgical success was defined as maintaining a healthy clear corneal surface post operatively. Results: There were 8 autolimbal and 9 allolimbal transplants. Of the latter, 8 were from living related donors (Lr-CLAL) and one was Keratolimbal Allograft (KLAL). Fifteen eyes had total LSCD and two eyes had partial LSCD. Primary diagnosis included combined chemical & thermal Injury burn (n=13), vernal keratoconjunctivits (n=2), herpes simplex infection (n=1) and idiopathic (n=1). Mean post operative follow-up was 50.65 ± 34.68 months (range 12- 108 months). CLAU was successful in 7 out of 8 eyes (87.5%). Mean VA improved from 0.1 ± 0.12 to 0.44 ± 0.28 (measured in decimal fraction). CLAL was successful in 2 out of 9 eyes (22.2%). Mean VA improved from 0.03 ± 0.04 to 0.10 ± 0.22. All eyes with CLAU achieved re-epithelialization and maintained an intact epithelium. Eyes with CLAL achieved re-epithelialization and maintained an intact epithelium in 66.7% (6). Conclusion: LSCT is an effective modality of treatment in patients with LSCD. CLAU transplant and absence of post operative complications were associated with statistically higher success rate. Younger patients and wet ocular surface had more favorable outcome.