CORNEAL STEM CELLS

The biotechnology and biological treatment of corneal lesions are reviewed. Ocular cicatrical pemphigoid and Steven's Johnson syndrome most often cause ocular damage and blindness not amenable to surgical correction. It is a problem in South Africa and other parts of the world. The only route may be the biological cell therapy one. Rameesh, et al from the Princess Alexandria Eye Pavilion, Edinburgh-UK, have demonstrated the application of ex-vivo expansion of corneal limbal epithelial/stem cells for corneal surface reconstruction. See Europ J of Opthalmol 13:515-524, 2003. Clearly, the surgical management of severe ocular surface disease due to limbal stem cell deficiency has changed considerably and academics will have to grapple with these new advances or be left behind.

BOLAND CELL : SCIENTIFIC AND ACADEMIC DISCUSSION (CORNEAL STEM CELLS).

The biological approach to corneal regeneration has been championed by astute workers such as Pellegrini and Nakamura. Japanese input has been strong. These references are valuable for the neophyte ophthalmologist entering biological cell therapy. Once bilateral corneal stem cell failure occurs for whatever reason, overgrowth of the conjunctival epithelium becomes problematical for the clinician. If no allografts are available the problem gets worse. The alternative is to proliferate stem cells from the contralateral eye and corneolimbal segment. But this associated with morbidity in inexperienced hands. One solution is to do corneal reconstruction with tissue engineered cell sheets composed of autologous oral mucosal epithelium. This has been shown to be feasible by Nishida et al, from Osaka University Medical School in Japan . See: N Engl J Med 2004, 351:1187-96. See other resources: Acta Ophthalmol 2004, 82:468-471; American J of Ophthal 1996: 122:38-52; Amer J Ophthal 1990: 646-656; The Lancet,349:1556,1997.