Treatment of limbal stem cell deficiency in the setting of neurotrophic keratopathy
Authors
Rozaliya HRISTOVA, Yani ZDRAVKOV, Maria HRISTOVA, Ivan TANEV
Institution
Medical University-Sofia, University Hospital Alexandrovska, Sofia
Country
Bulgaria
Year
2020
Journal
Journal of International Translational Medicine
Abstract
This study examined the application of cell-based therapy as treatment for severe neurotrophic keratopathy, associated with
limbal stem cell deficiency. Autologous limbal epithelial stem cells from ten patients with neurotrophic keratopathy were cultured
on human amniotic membrane. Cochet-Bonnet esthesiometry demonstrated reduced to absent corneal sensation. A matrix
metalloproteinase-9-based test was used to evaluate ocular surface inflammation. Conjunctivalization of the corneal surface was
confirmed on impression cytology. Anterior segment optical coherence tomography was used before and after the intervention.
A limbal biopsy was taken from a sector with preserved palisades of Vogt of the affected eye. The harvested limbal stem cells were
cultured using a novel explant culture system without xenobiotic products. The grafts were transplanted to the affected eye in
14 days. Success of the procedure was defined as complete epithelialization, reduction of neovascularization, improved corneal
transparency, thickness and reflex. Successful ex vivo expansion of the harvested cells was achieved from all biopsies. Clinical
recovery was observed in all patients, as well as improvement of subjective ocular comfort. Success criteria were met in all cases.
Ocular surface reconstruction in severe neurotrophic keratopathy, associated with limbal stem cell deficiency is possible with
cell-based therapy as a safe and effective treatment method.