In Vivo Cultivation of Limbal Stem Cells Using Platelet-rich Plasma Eye Drops (E-PRP): A Case Series
Alireza Baradaran-Rafii1 , Saeed Heidari-Keshel2 , Nazanin Behnaz3 *
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Tissue Engineering and Applied Cell Science, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: To introduce a new method of limbal stem cell transplantation using platelet-rich plasma (E-PRP) eye drops for unilateral total limbal stem cell deficiency (LSCD).
Methods: Patients with total unilateral LSCD due to chemical burn underwent in vivo cultivated limbal epithelial transplantation (CLET) using E-PRP drops. One small limbal block, measuring 2 × 1 mm, was harvested from the patients' contralateral healthy eye and transplanted to the involved eye. All patients received E-PRP drops which were continued until complete corneal epithelialization. Subsequent corneal transplantation was performed in eyes with significant stromal opacity to restore visual acuity. Corneal buttons obtained during corneal transplantation were submitted to immunohistochemistry for the evaluation of limbal stem cell markers. Visual acuity, epithelial healing, corneal clarity, and regression of corneal conjunctivalization/vascularization were evaluated after surgery.
Results: Ten patients were included in this study. The mean patient age was 29.5 ± 6.7 years (range, 16-38 years). All patients had been injured by acid (n=7) or alkali (n=3) chemical agents. The time interval between ocular surface damage and surgery was more than 6 months in all cases. The mean follow-up period was 22.5±7.36 months (range, 12-32 months). Corneas were completely re-epithelialized within 14.9±3.6 days (range, 11 - 21 days). Corneal conjunctivalization/vascularization regressed dramatically 1-2 months after surgery in all cases, and the cornea regained considerable clarity in 7 patients. Subsequent optical PKP was performed in three eyes with significant stromal opacification. The ocular surface was stable throughout the follow-up period in all eyes. Best spectacle-corrected visual acuity (BSCVA) was hand motion to count fingers before surgery in all cases. In eyes with and without PKP, BSCVA improved to 0.61±0.36 and 0.47±0.23 LogMAR at the last follow-up visit, respectively. Limbal stem cell markers (ABCG2 and P63) were detected on corneal buttons after keratoplasty.
Conclusion: Based on our clinical and laboratory findings, this procedure (in vivo CLET) is effective and can be considered a promising alternative for ocular surface reconstruction.
