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| Cornea > Stem Cell Transplantation | ||||||
LSCT is extremely useful in the management of unilateral chemical injury, it has not been extensively applied to the management of bilateral chemical injury. Recent innovations that can be used in such cases are limbal allograft transplantation or the use of cultured limbal stem cells. |
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In cases of unilateral chemical injuries limbal autografting from the fellow eye as an early intervention as early as 3 weeks after injury offers the potential of a phenotypically normal ocular surface. This in turn reduces or prevents conjunctivalisation of cornea that results in a thickened vascularized, irregular and unstable cornea. |
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Bilateral stem cell loss, as in cases of bilateral chemical injuries, living related allograft procedures can be done. Donor with the best ABO blood and HLA tissue match is chosen. Surgical procedure is similar to conjunctival limbal autografting. But to reduce the risk of rejection systemic immunosuppression is routinely employed. |
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If a suitable living donor is unavailable a cadaveric allograft is recommended. In this a circular allograft is obtained from donor corneal button that is then sewn into position with 10/0 nylon sutures on the corneal side and 8/0 vicryl sutures on the scleral side. Systemic immunosuppression is again employed to prevent allograft rejection. This procedure is advantageous as it is available to all patients and eliminates risk to the donor. |
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In 1993 Lindbergetal were able to propagate ocular epithelial cell in vitro. This tissue culture work was the basis for recent autologous transplantation of cultivated corneal epithelium. Full thickness 1-2mm² biopsies from the limbs of health eyes were taken and cultured on cellular human amniotic membrane. These were then autografted onto the fellow affected eyes. So in the future limbal stem cell cultures may be used as the source for all limbal transplantation including autografts and allografts. |
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