Transplantation of a bioengineered serum-free derived conjunctival epithelial equivalent for the treatment of severe corneal and ocular surface disease

Abstract

Aim: To investigate the use of a cultivated conjunctival epithelial sheet for the reconstruction of the corneal surface in severe cornea and ocular surface disease. Methods: Five eyes of 5 patients with severe ocular surface disorders were studied. Four eyes had chemical injuries, while the last had recurrent pterygium with limbal deficiency. Conjunctival tissue was harvested and cultivated on human amniotic membrane under serum-free conditions. Patients underwent excision of the diseased tissue and transplantation of the cultivated conjunctival epithelial sheet 2 weeks later. Patients were examined pre-operatively and post-operatively looking for improvement in patient symptomatology, visual acuity and the state of the ocular surface. The integrity of the epithelial sheet was tested with fluorescein staining. Results: A confluent stratified conjunctival epithelial sheet was formed within 2 weeks. Transplanted grafts remained well-epithelialised after surgery. Four of 5 eyes (80%) had visual improvement with all patients having significantly improved symptomatology and reduction in inflammation and corneal neovascularisation. Conclusions: Cultivated autologous conjunctiva on human amniotic membrane successfully reconstructed the ocular surface of patients with severe ocular surface disease and limbal deficiency. This is a suitable alternative modality in corneal epithelial replacement, especially in patients with bilateral disease.