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Bulgarian Review of Ophthalmology

Transplantation of ex vivo expanded limbal stem cells in neurotrophic keratopathy - a case report

R. Hristova, Y. Zdravkov, M. Hristova, I. Tanev


We present a case of neurotrophic keratopathy associated with limbal stem cell deficiency, treated by transplantation of autologous ex vivo expanded limbal stem cells. The applied diagnostic methods include slit-lamp examination, microbiological samples from conjunctiva and corneal lesion, polymerase chain reaction of aqueous humor for herpes virus DNA, anterior segment optical coherence tomography. Since no improvement was observed with conservative treatment, a minimally invasive limbal biopsy and transplantation of amniotic membrane were performed. The collected autologous limbal stem cells were expanded ex vivo using an innovative protocol without xenobiotic products on intact amniotic membrane. After sufficient epithelial layers were obtained ex vivo the graft was transplanted on the ocular surface of the patient. Postoperatively the corneal surface was completely covered by epithelium, visual acuity improved significantly. Regression of neovascular vessels was observed and all symptoms of chronic inflammation were alleviated. Transplantation of ex vivo expanded limbal stem cells on amniotic membrane can be an effective treatment method for neurotrophic keratopathy, associated with limbal stem cell deficiency.


Transplantation; limbal stem cells; neurotrophic keratopathy; 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

M. Hristova
University Hospital Alexandrovska, Clinic of Nephrology, Medical University - Sofia, Department of Clinical Laboratory and Clinical Immunology

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