Background. A healthy cornea is reliant on a distinct population of stem cells (SC) that replace damaged or aging epithelium throughout life. Depletion of the SC pool or damage to the niche can result in a blinding and painful condition known as limbal-SC deficiency (LSCD). Although current treatment strategies for reconstituting the ocular surface for patients suffering LSCD are promising, they are complicated by transferring autologous or allogeneic progenitors in the presence of animal, human, and synthetic products. We report on the safe and efficacy of a unique autologous SC transfer technique that utilizes an Food and Drug Administration-approved contact lens (CL) as the SC substrate and carrier for patients with LSCD.
Methods. Three patients with LSCD due to aniridia (n=1) and posttreatment for recurrent ocular surface melanoma (n=2) were included. Limbal (n=2) or conjunctival biopsies (n=1) were harvested and progenitors expanded ex vivo on therapeutic CLs in the presence of autologous serum. Cell-laden CLs were transferred to the patient's corneal surface and clinical outcome measures were recorded (follow-up range, 8–13 months).
Results. A stable transparent corneal epithelium was restored in each patient. There was no recurrence of conjunctivalization or corneal vascularization, and a significant improvement in symptom score occurred in all patients. Best-corrected visual acuity was increased in all eyes after the procedure.
Conclusion. Ex vivo expansion of ocular surface epithelium in the presence of autologous serum and transplantation with the aid of a soft CLs is a promising new technique capable of achieving ocular surface rehabilitation.
1Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.
2Department of Ophthalmology, Prince of Wales Hospital, Sydney, NSW, Australia.
3Department of Ophthalmology, University Hospital Zurich, Switzerland.
This work was supported by Career Development Fellowship from the National Health and Medical Research Council of Australia (455358) (N.D.G.) and Health Practitioner Training Fellowship from the National Health and Medical Research Council of Australia (394000) (S.L.W.).
4Address correspondence to: Nick Di Girolamo, Ph.D., Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
Received 12 September 2008. Revision requested 7 October 2008.
Accepted 12 February 2009.