Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation

Kazuo Tsubota, Yoshiyuki Satake, Minako Kaido, Naoshi Shinozaki, Shigeto Shimmura, Hiroko Bissen-Miyajima, Jun Shimazaki

Research output: Contribution to journalArticle

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Abstract

Background: Conditions that destroy the limbal area of the peripheral cornea, such as the Stevens-Johnson syndrome, ocular pemphigoid, and chemical and thermal injuries, can deplete stem cells of the corneal epithelium. The result is scarring and opacification of the normally clear cornea. Standard corneal transplantation cannot treat this form of functional blindness. Methods: We performed and evaluated 70 transplantations of corneal epithelial stem cells from cadaveric eyes into 43 eyes of 39 patients with severe ocular-surface disorders and limbal dysfunction. Medical treatment had failed in all patients. The patients had a mean preoperative visual acuity of 0.004 (only being able to count the number of fingers presented by the examiner) in the affected eyes, which satisfies the criteria for legal blindness in most countries. In 28 eyes, we also performed standard corneal transplantation. Stem-cell transplantations were performed as many as four times on I eye if the initial results were not satisfactory; 19 eyes had multiple transplantations. Patients were followed for at least one year after transplantation. Results A mean of 1163 days after stem-cell transplantation, 22 of the 43 eyes (51 percent) had corneal epithelialization; of the 22 eyes, 7 eyes had corneal stromal edema and 15 eyes had clear corneas. Mean visual acuity improved from 0.004 to 0.02 (vision sufficient to distinguish the largest symbol on the visual-acuity chart from a distance of 1 m) (P<0.001). The 15 eyes in which the cornea remained clear had a final mean visual acuity of 0.11 (the ability to distinguish the largest symbol from a distance of 5 m). Complications of the first transplantation included persistent defects in the corneal epithelium in 26 eyes, ocular hypertension in 16 eyes, and rejection of the corneal graft in 13 of 28 eyes. The epithelial defects eventually healed in all but two of the eyes. Conclusions: Transplantation of corneal epithelial stem cells can restore useful vision in some patients with severe ocular-surface disorders.

Original languageEnglish
Pages (from-to)1697-1703
Number of pages7
JournalNew England Journal of Medicine
Volume340
Issue number22
DOIs
Publication statusPublished - 1999 Jun 3

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Stem Cell Transplantation
Epithelial Cells
Corneal Transplantation
Therapeutics
Cornea
Visual Acuity
Corneal Epithelium
Stem Cells
Transplantation
Blindness
Naphazoline
Corneal Edema
Bullous Pemphigoid
Ocular Hypertension
Stevens-Johnson Syndrome
Aptitude
Graft Rejection

ASJC Scopus subject areas

  • Medicine(all)

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Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation. / Tsubota, Kazuo; Satake, Yoshiyuki; Kaido, Minako; Shinozaki, Naoshi; Shimmura, Shigeto; Bissen-Miyajima, Hiroko; Shimazaki, Jun.

In: New England Journal of Medicine, Vol. 340, No. 22, 03.06.1999, p. 1697-1703.

Research output: Contribution to journalArticle

Tsubota, Kazuo ; Satake, Yoshiyuki ; Kaido, Minako ; Shinozaki, Naoshi ; Shimmura, Shigeto ; Bissen-Miyajima, Hiroko ; Shimazaki, Jun. / Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation. In: New England Journal of Medicine. 1999 ; Vol. 340, No. 22. pp. 1697-1703.
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AU - Satake, Yoshiyuki

AU - Kaido, Minako

AU - Shinozaki, Naoshi

AU - Shimmura, Shigeto

AU - Bissen-Miyajima, Hiroko

AU - Shimazaki, Jun

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