Treatment of Limbal Stem Cell Deficiency in the Setting of Neurotrophic Keratopathy

• Main Authors: Rozaliya HRISTOVA, Yani ZDRAVKOV, Maria HRISTOVA, Ivan TANEV
• Format: Article
• Language: English
• Published: Third Party Medicine International Publishing Group Co. Limited 2020-06-01
• Series: Journal of International Translational Medicine
• Subjects: cultured limbal epithelial transplantation; neurotrophic keratopathy; treatment
• Online Access: http://dx.doi.org/10.11910/2227-6394.2020.08.02.02

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.