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Comparison of the efficacy of different cell sources for transplantation in total limbal stem cell deficiency

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Abstract

Purpose

The purpose of this study was to compare the efficacy of allogeneic cultured limbal epithelial transplantation (ACLET) and cultivated oral mucosal epithelial transplantation (COMET) in treating total limbal stem cell deficiency (LSCD).

Methods

In this retrospective cohort study, 73 patients (76 eyes) with total LSCD, including 41 patients (42 eyes) treated with ACLET and 32 patients (34 eyes) receiving COMET, were evaluated. The age, gender and injury cause of all patients were recorded.

Results

The mean follow-up was 23.3 ± 9.9 months in the ACLET group and 16.1 ± 5.8 months in the COMET group. A higher incidence of persistent epithelial defect was observed after COMET (P = 0.023). The overall ocular surface grading scores were all lower in the ACLET group than in the COMET group at 3, 6, and 12 months after surgery and the last follow-up. Kaplan-Meier survival curve analysis demonstrated a significantly higher success rate of ACLET (71.4%), compared with that of COMET (52.9%; P = 0.043). The risk of graft failure was higher in patients with entropion and trichiasis, incomplete eyelid closure and treated with COMET. The graft failure risk rate after COMET was 3.5 times higher than that of ACLET.

Conclusions

For total LSCD patients, ACLET should be prioritized, since limbal epithelial cells have better ability to maintain corneal epithelial integrity and ocular surface stability and benefit the ocular surface when compared with oral mucosal epithelial cells. Preoperative and postoperative eyelid abnormalities should be corrected as early as possible.

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Funding

This study was supported by the Natural Science Foundation of Shandong Province (ZR2014HQ059) and the Young and Middle-Aged Scientists Research Awards Fund of Shandong Province (ZR2017BH004).

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Author notes

  1. Junyi Wang and Xiaolin Qi contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Ophthalmology and Visual Science Key Laboratory of PLA, Chinese PLA General Hospital, Beijing, China

    Junyi Wang

  2. State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, 5 Yanerdao Road, Qingdao, 266071, China

    Junyi Wang, Yanling Dong, Jun Cheng, Hualei Zhai, Qingjun Zhou & Lixin Xie

  3. Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China

    Xiaolin Qi

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  1. Junyi Wang
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Correspondence to Lixin Xie.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wang, J., Qi, X., Dong, Y. et al. Comparison of the efficacy of different cell sources for transplantation in total limbal stem cell deficiency. Graefes Arch Clin Exp Ophthalmol 257, 1253–1263 (2019). https://doi.org/10.1007/s00417-019-04316-z

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  • DOI: https://doi.org/10.1007/s00417-019-04316-z

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