DAVID GRANOVSKY

CHEMICALLY BURNED EYES REPAIRED WITH STEM CELLS

In VICTORIES & SUCCESS STORIES on June 24, 2010 at 12:47 pm

BRIEF SUMMARY OF METHODS

  1. used autologous limbal stem cells cultivated on fibrin
  2. treated 112 patients with corneal damage
  3. most had burn-dependent limbal stem-cell deficiency

BRIEF SUMMARY OF RESULTS

  1. Permanent restoration of a transparent, renewing corneal epithelium was attained in 76.6% of eyes.
  2. Restored eyes remained stable over time, with up to 10 years of follow-up (mean, 2.91±1.99; median, 1.93).
  3. Cultures in which p63-bright cells constituted more than 3% of the total number of clonogenic cells were associated with successful transplantation in 78% of patients.

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MORE DETAILED INFORMATION:

http://content.nejm.org/content/vol0/issue2010/images/large/NEJMoa0905955f3.jpeg

Figure 3. Regeneration of a Functional Corneal Epithelium and Restoration of Visual Acuity.

[Brief: “All three eyes had total limbal stem-cell deficiency, complete corneal opacification, and stromal scarring (images at left).  In all three patients, autologous limbal stem-cell cultures successfully regenerated functional corneal epithelium.“]

Panel A shows the left eye of Patient 93 (see Table 1 in the Supplementary Appendix, available with the full text of this article at NEJM.org), who had total limbal stem-cell deficiency due to an acid burn (image at left). His visual acuity was reduced to counting fingers. A graft of autologous limbal cultures was sufficient to regenerate functional corneal epithelium (image at right) and to restore normal vision (visual acuity, 0.7), since the eye had no stromal scarring. Panel B shows the eyes of Patients 22, 26, and 46 (see Table 1 in the Supplementary Appendix), which were damaged by alkali burns and were treated with unsuccessful surgery 13, 30, and 3 years before admission, respectively. All three eyes had total limbal stem-cell deficiency, complete corneal opacification, and stromal scarring (images at left). Vision was reduced to counting fingers (in Patient 22) or perceiving hand movements (in Patients 26 and 46). In all three patients, autologous limbal stem-cell cultures successfully regenerated functional corneal epithelium. To improve their visual acuity after grafting, the patients underwent penetrating keratoplasty. In all three eyes, the engrafted limbal stem cells resurfaced the donor stroma. At the last follow-up visits (at 6, 6.5, and 4 years, respectively), all eyes were covered by stable corneal epithelium (images at right). The keratoplasty resulted in complete restoration of visual acuity in Patients 22 and 46 (0.9 and 0.8, respectively). The visual acuity of Patient 26 increased to only 0.3 because of a concomitant amblyopia (the alkali burn had occurred 30 years before admission). In Patient 46, the follow-up image shows that the conjunctival vessels stop at the conjunctival–corneal boundary (arrowheads); they do not invade the restored corneal surface.

http://content.nejm.org/content/vol0/issue2010/images/large/NEJMoa0905955f1.jpeg

Figure 1. Kaplan–Meier Estimates of Grafted Limbal Stem-Cell Survival.

[Brief: “the final clinical outcome was deemed a success in 76.6% of the eyes treated“]

Panel A shows the survival estimates for the cultures after one graft was placed, with partial or total success attained in 68.2% of the eyes treated. Panel B shows survival estimates after a second graft was placed in 11 eyes (a total of 12 additional grafts, since 1 eye was regrafted twice), indicating either partial success or failure. After regrafting, 9 of these eyes regenerated normal epithelium. Thus, the final clinical outcome was deemed a success in 76.6% of the eyes treated. All failures occurred within the first year after grafting, whereas successful cultures remained stable for up to 10 years of follow-up.

THIS POST IS AN ADDENDUM TO EARLIER STORY:  Stem Cells From Own Eyes Restore Vision to Blinded Patients, Study Shows – Bloomberg – VIA

THE IMAGES AND TEXT ARE VIA: http://content.nejm.org/cgi/content/full/NEJMoa0905955v1#F3

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