Background Conditions that destroy the limbal area of the peripheralcornea, such as the Stevens–Johnson syndrome, ocular pemphigoid,and chemical and thermal injuries, can deplete stem cells ofthe corneal epithelium. The result is scarring and opacificationof the normally clear cornea. Standard corneal transplantationcannot treat this form of functional blindness.
Methods We performed and evaluated 70 transplantations of cornealepithelial stem cells from cadaveric eyes into 43 eyes of 39patients with severe ocular-surface disorders and limbal dysfunction.Medical treatment had failed in all patients. The patients hada mean preoperative visual acuity of 0.004 (only being ableto count the number of fingers presented by the examiner) inthe affected eyes, which satisfies the criteria for legal blindnessin most countries. In 28 eyes, we also performed standard cornealtransplantation. Stem-cell transplantations were performed asmany as four times on 1 eye if the initial results were notsatisfactory; 19 eyes had multiple transplantations. Patientswere followed for at least one year after transplantation.
Results A mean of 1163 days after stem-cell transplantation,22 of the 43 eyes (51 percent) had corneal epithelialization;of the 22 eyes, 7 eyes had corneal stromal edema and 15 eyeshad clear corneas. Mean visual acuity improved from 0.004 to0.02 (vision sufficient to distinguish the largest symbol onthe visual-acuity chart from a distance of 1 m) (P<0.001).The 15 eyes in which the cornea remained clear had a final meanvisual acuity of 0.11 (the ability to distinguish the largestsymbol from a distance of 5 m). Complications of the first transplantationincluded persistent defects in the corneal epithelium in 26eyes, ocular hypertension in 16 eyes, and rejection of the cornealgraft in 13 of 28 eyes. The epithelial defects eventually healedin all but two of the eyes.
Conclusions Transplantation of corneal epithelial stem cellscan restore useful vision in some patients with severe ocular-surfacedisorders.
Source Information
From the Department of Ophthalmology, Tokyo Dental College, Chiba (K.T., Y.S., M.K., N.S., S.S., H.B.-M., J.S.); and the Department of Ophthalmology, Keio University School of Medicine, Tokyo (K.T., S.S., H.B.-M.) — both in Japan.
Address reprint requests to Dr. Tsubota at the Department of Ophthalmology, Tokyo Dental College, 11-13 Sugano 5 Chome, Ichikawa-shi, Chiba 272-8513, Japan, or at kazuo{at}eyebank.or.jp.
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