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Safety outcomes and long-term effectiveness of ex vivo autologous cultured limbal epithelial transplantation for limbal stem cell deficiency
  1. Adriano Fasolo1,2,
  2. Emilio Pedrotti2,
  3. Mattia Passilongo2,
  4. Giorgio Marchini2,
  5. Cristina Monterosso3,
  6. Roberto Zampini3,
  7. Elisabetta Bohm3,
  8. Federica Birattari4,
  9. Antonella Franch4,
  10. Vanessa Barbaro1,
  11. Marina Bertolin1,
  12. Claudia Breda1,
  13. Enzo Di Iorio1,5,
  14. Barbara Ferrari1,
  15. Stefano Ferrari1,
  16. Mauro Meneguzzi1,
  17. Diego Ponzin1
  1. 1Fondazione Banca degli Occhi del Veneto (The Veneto Eye Bank Foundation), Venezia Zelarino, Italy
  2. 2Department of Neurosciences, Biomedicine, and Movement Sciences, Eye Clinic, AOUI—University of Verona, Italy
  3. 3Ophthalmology Unit, Ospedale dell'Angelo, ULSS 12 Veneziana, Venezia Zelarino, Italy
  4. 4Ophthalmology Unit, Ospedale SS. Giovanni e Paolo, ULSS 12 Veneziana, Venezia, Italy
  5. 5Department of Molecular Medicine, University of Padua, Padua, Italy
  1. Correspondence to Dr Adriano Fasolo, Fondazione Banca degli Occhi del Veneto (The Veneto Eye Bank Foundation)—Padiglione G. Rama, Via Paccagnella 11, Venezia Zelarino 30174, Italy; adriano.fasolo{at}


Purpose To evaluate the safety and effectiveness of ex vivo autologous cultured limbal stem cell transplantation (CLET).

Methods We reviewed the clinical records of 59 consecutive patients treated with 65 CLETs. Efficacy was graded 1 year after surgery as successful, partially successful or failed. A safety analysis was performed considering side effects and complications that were recorded during the first year after CLET and those reported later than 1 year, including the events related to subsequent treatments.

Results The mean post-CLET follow-up was 6.0±4.1 years. 69% of CLETs had either one or more adverse events (AEs), or adverse drug reactions (ADRs), within 1 year of surgery, with inflammation being the most common (42%), followed by corneal epithelium defects/disepithelialisation (31%), and blood coagula under the fibrin (24%). One year after surgery, 41% of the 59 primary CLET procedures were successful, 39% partially successful and 20% failed. The most common ADRs recorded for the primary unsuccessful CLETs were ulcerative keratitis, melting/perforation, and epithelial defects/disepithelialisation. Six failed CLETs required reconstructive penetrating keratoplasty (PK). Among CLETs with a favourable outcome, 13 underwent corrective PK (mean 4.8±3.4 years), and thereafter seven eyes maintained integrity of the corneal epithelium, five showed corneal surface failure, and one had recurrent epithelial defects. Corneal graft rejection episodes were reported in 71% and 58% of patients following corrective or reconstructive PK, respectively. Seven primary CLETs with a favourable outcome worsened thereafter, and the overall 3-year long-term effectiveness was 68%.

Conclusions This study addresses important issues regarding possible risks associated with disarray of the ocular surface homeostasis following autologous CLET in patients with limbal stem cell deficiency, despite the fact that the majority of patients experienced a favourable long-term benefit.

  • Stem Cells
  • Cornea
  • Ocular surface

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