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Clinical outcomes of xeno-free autologous cultivated limbal epithelial transplantation: a 10-year study
  1. Virender S Sangwan1,2,
  2. Sayan Basu1,2,
  3. Geeta K Vemuganti2,
  4. Kunjal Sejpal1,
  5. Sandhya V Subramaniam3,
  6. Souvik Bandyopadhyay4,
  7. Sannapaneni Krishnaiah5,
  8. Subhash Gaddipati2,6,
  9. Shubha Tiwari2,6,
  10. Dorairajan Balasubramanian2,3,6
  1. 1Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, India
  2. 2Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, L V Prasad Eye Institute, Hyderabad, India
  3. 3Professor Brien Holden Eye Research Center, L V Prasad Eye Institute, Hyderabad, India
  4. 4Indian Institute of Public Health, Hyderabad, India
  5. 5Department of Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, India
  6. 6Champalimaud Translational Center for Eye Research, L V Prasad Eye Institute, Hyderabad, India
  1. Correspondence to Dr Virender S Sangwan, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Road No.2, Banjara Hills, Hyderabad 500034, India; vsangwan{at}


Purpose Ocular burns can damage the corneal epithelial stem cells located at the limbus. This study evaluated the efficacy of xeno-free autologous cell-based treatment of limbal stem cell deficiency.

Methods This retrospective study included 200 patients, above 8 years of age, with clinically diagnosed unilateral total limbal stem cell deficiency due to ocular surface burns treated between 2001 and 2010. A small limbal biopsy was obtained from the unaffected eye. The limbal epithelial cells were expanded ex vivo on human amniotic membrane for 10–14 days using a xeno-free explant culture system. The resulting cultured epithelial monolayer and amniotic membrane substrate were transplanted on to the patient's affected eye. Postoperative corneal surface stability, visual improvement and complications were objectively analysed.

Results A completely epithelised, avascular and clinically stable corneal surface was seen in 142 of 200 (71%) eyes at a mean follow-up of 3±1.6 (range: 1–7.6) years. A two-line improvement in visual acuity, without further surgical intervention, was seen in 60.5% of eyes. All donor eyes remained healthy.

Conclusions Autologous cultivated limbal epithelial transplantation using a xeno-free explant culture technique was effective in long-term restoration of corneal epithelial stability and improvement of vision in eyes with ocular surface burns.

  • Limbal stem cell deficiency
  • xeno-free
  • autologous
  • cultivated limbal epithelial transplantation
  • ocular surface burns
  • iris
  • sclera and episclera
  • ocular surface
  • cornea
  • immunology
  • imaging
  • ocular surface
  • stem cells
  • epidemiology
  • angiogenesis

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  • Funding This work was funded by a competitive grant from the Department of Biotechnology, India (BT/01/COE/06/02/10), a partnership grant from the Champalimaud Foundation, Portugal, and support from Sudhakar and Sreekanth Ravi, California, USA (for equipment and laboratory infrastructure). None of these had any role in the design, collection, analysis and interpretation of the data.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee, L V Prasad Eye Institute, Hyderabad, India.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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