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Ocular surface reconstruction, amniotic membrane, and cultivated epithelial cells from the limbus
  1. N Koizumi,
  2. S Kinoshita
  1. Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
  1. Correspondence to: Noriko Koizumi MD, PhD, Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kawaramachi-hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan;

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Amniotic membrane has an inhibitory effect against transformation of keratocytes to myofibroblasts

Severe ocular surface diseases such as Stevens-Johnson syndrome and ocular cicatricial pemphigoid, as well as a wide range of debilitating chemical injuries, have at their core a deficiency of corneal epithelial cells at the limbus. This is because the corneal epithelial stem cells reside in this region of the eye, indicated by the presence of palisades of Vogt,1 and when the limbal epithelium is destroyed the corneal surface becomes enveloped by conjunctival tissue with superficial scarring and vascularisation often accompanying a persistent epithelial defect. To surgically reconstruct these eyes a keratolimbal graft—either from the other, healthy eye of the same patient (autograft) or from donor material (allograft)—can be carried out,2 and this approach has been beneficial in a number of situations. Autografts, however, are not an option for bilateral injuries, and even when they are feasible have drawbacks because they require a fairly large limbal graft be taken from the healthy eye which is not without risk. Allografts are not ideal as they invariably carry the risk of rejection.

Recently, a new approach that involves the transplantation of cultivated corneal limbal cells to treat stem cell deficient eyes has provided promising results.3–7 Initial work established the premise that cells from healthy limbal tissue could be cultivated in the laboratory and grafted onto …

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