• Prospective Trial of Corneal Reconstruction With Biomaterial-Free COMECs

    Written By: Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    Cornea
    2018;37(1):76-83

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    Conventional therapeutic options for limbal stem cell deficiency (LSCD) are allogenic limbal graft transplantation and autologous conjunctivolimbal graft from the contralateral eye. However, regenerative medicine involving adult stem cells for ocular reconstruction is gaining popularity. Kim et al. studied the efficacy and safety of transplanting biomaterial-free cultured oral mucosal epithelial cell sheets (COMECs) for ocular reconstruction in patients with total LSCD. Their findings indicate that the procedure is generally safe and efficacious for this purpose.

    For this prospective trial, which was conducted in Seoul, South Korea, the researchers included 8 patients with complete LSCD. COMECs were prepared in a culture system without temperature-sensitive polymers or car­riers. The sheets were transplanted but not sutured. After transplant stabiliza­tion, 4 patients underwent penetrating keratoplasty. During the subsequent 6 months, the authors documented stability of epithelialization, changes in visual acuity, and postoperative compli­cations. Immunofluorescent staining of corneal cytokeratins (K) was conducted for the patients who underwent pene­trating keratoplasty.

    The ocular surface was successfully reconstructed in 6 eyes. Complete sta­ble epithelialization was achieved in a mean of 53.6 days. Five eyes had visual improvement of ≥ 2 lines. The proce­dure failed in 2 eyes, which exhibited full symblepharon in all 4 quadrants. Following keratoplasty, the corneal phenotypic marker (K12) and mucosal phenotypic markers (K4 and K13) were well expressed, suggesting that COMECs acquire part of the corneal phenotype. K1, K8, and K19 showed minimal expression. No ocular infections or noteworthy systemic complications were reported. Finally, local tumor formation was not observed in any patient.

    Although these findings indicate that transplantation of biomaterial-free COMECs is generally effective and safe for reconstructing the ocular surface in patients with LSCD, it may be prudent to exclude candidates who have com­plete symblepharon in all 4 quadrants. Meticulous postoperative care is crucial to maintain stability of the COMECs and to optimize overall outcomes.

    The original article can be found here.