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Bulgarian Review of Ophthalmology

Transplantation of ex vivo expanded limbal stem cells

R. Hristova, Y. Zdravkov, I. Tanev


Purpose: To investigate the application of autologous ex vivo expanded limbal stem cell transplantation in the management of ocular surface disease. Materials and methods: Autologous ex vivo expanded stem cells were transplanted to four patients with mean age 56.5 years from the Depmtment of Ophthalmology, University Hospital Alexandrovska. All patients presented signs of unilateral limbal stem cell deficiency, associated with trophic disease of the ocular surface, which was demonstrated on impression cytology. After informed consent was obtained a minimally invasive limbal biopsy was performed. The limbal materials were cultured using a novel protocol without additional xenobiotic products. The grafts were transplanted after fourteen days. Anterior segment optical coherence tomography before and after the intervention was used for assessment of the condition. Success of the procedure was defined as 1. Complete epithelialization of the corneal surface, 2. partial or complete reduction of neovascularization, 3. achieving normal corneal transparency, thickness and reflex, 4. visual acuity improvement. Results: Clinical recovery was observed in all patients, as well as improvement of subjective ocular comfort. In three of the cases all four success criteria were met. Visual acuity of one patient did not change, due to neoplastic process, pervading the optic nerve. No graft rejection reactions were observed. Limbal biopsy did not induce limbal stem cell deficiency in the donor eye. Conclusion: Transplantation of autologous ex vivo expanded limbal stem cells is an effective and safe method for ocular surface reconstruction, which can be applied in different conditions, associated with limbal stem cell deficiency.

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About The Authors

R. Hristova
Medical University - Sofia, University Hospital Alexandrovska, Department of Ophthalmology

Y. Zdravkov
Medical University - Sofia, University Hospital Alexandrovska, Department of Ophthalmology

I. Tanev
Medical University - Sofia, University Hospital Alexandrovska, Department of Ophthalmology