Good microenvironment key for fibrin-cultured limbal stem cell replacement

WASHINGTON – Creating a good postoperative microenvironment for patients who have undergone autologous fibrin-cultured limbal stem cell replacement can be the key to successful long-term results, according to Elisabetta Bohm, MD.

During the World Cornea Congress here, Dr. Bohm presented preliminary results of a 2002 study of eight patients who had received such implants.

“We can conclude that this technique is very safe … it is fully standardized, and the availability of a second cell culture is a great additional chance we can offer to the patient,” Dr. Bohm said. “This positive aspect compensates for the downside of this technique. It is currently a high cost.”

Five patients received fresh implants, and three received frozen implants, Dr. Bohm said.

All of the patients had unilateral burns and severe unilateral limbal deficiencies. Exclusion criteria included patients who suffered from other impairments such as inflammation.

“The graft has to be applied on a small surface and under the conjunctival pocket in order to keep it in place without any kind of sutures on the cells,” Dr. Bohm explained.

Postoperative therapy is based on preservative-free antibiotics, steroids and lubricants, she said.

“Our latest concerns in the first follow-up have been hemorrhages, thickness and patient compliance,” she said.

A “good microenvironment” is the quick answer, Dr. Bohm said.

“We have, on the 10th day postop, a complete epithelium; that is why our current target is to prevent hemorrhages and to be in the best possible environments for the cells to let them settle down,” she said.