Ocular surface reconstruction with tissue-engineered corneal epithelium

Objective To investigate the short-term outcome of ocular surface reconstruction with tissue-engineered corneal epithelium in the treatment of total limbal stem cell deficiency (LSCD). Methods In a case series, 6 eyes of 6 patients with total LSCD resulting from severe chemical injury (3 eyes), blast injury (2 eyes), or thermal burn (1 eye) were included in this study. Denuded amniotic membrane was used as the carrier to culture autologous corneal epithelial stem cells to construct tissue-engineered corneal epithelium. After that, tissue-engineered corneal epithelium was transplanted onto the LSCD ocular surface after removal of the corneal pannus. Visual acuity, slit lamp photography, ultrasound biomicroscopy (UBM) and Schirmer I test were performed before surgery and during the follow-up. Results After cell culture for 3 weeks, the autologous corneal epithelial cells proliferated and formed a stratified epithelial cell sheet 15 mm in diameter. All tissue-engineered corneal epithelia were successfully transplanted onto the ocular surface of the LSCD patients. Three months after surgery, there were no epithelial defects in the recipient corneas and the corneal surface remained smooth. Corneal scar tissue was removed and the pannus was significantly reduced. There was an improvement in visual acuity in all patients. Conclusion Transplantation of tissue-engineered corneal epithelia based on the ex-vivo expansion of autologous corneal epithelial stem cells may be an effective treatment to reconstruct the ocular surface of LSCD patients. Key words: Stem cells, epithelium, corneal; Tissue engineering; Reconstructive surgical procedure, ocular