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Romano V, Passaro ML, Ruzza A, Parekh M, Airaldi M, Levis HJ, Ferrari S, Costagliola C, Semeraro F, Ponzin D. Quality assurance in corneal transplants: Donor cornea assessment and oversight. Surv Ophthalmol 2024; 69:465-482. [PMID: 38199504 DOI: 10.1016/j.survophthal.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
The cornea is the most frequently transplanted human tissue, and corneal transplantation represents the most successful allogeneic transplant worldwide. In order to obtain good surgical outcome and visual rehabilitation and to ensure the safety of the recipient, accurate screening of donors and donor tissues is necessary throughout the process. This mitigates the risks of transmission to the recipient, including infectious diseases and environmental contaminants, and ensures high optical and functional quality of the tissues. The process can be divided into 3 stages: (1) donor evaluation and selection before tissue harvest performed by the retrieval team, (2) tissue analysis during the storage phase conducted by the eye bank technicians after the retrieval, and, (3) tissue quality checks undertaken by the surgeons in the operating room before transplantation. Although process improvements over the years have greatly enhanced safety, quality, and outcome of the corneal transplants, a lack of standardization between centers during certain phases of the process still remains, and may impact on the quality and number of transplanted corneas. Here we detail the donor screening process for the retrieval teams, eye bank operators. and ophthalmic surgeons and examine the limitations associated with each of these stages.
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Affiliation(s)
- Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Eye Clinic, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy.
| | - Maria Laura Passaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Alessandro Ruzza
- International Center for Ocular Physiopathology, Fondazione Banca Degli Occhi del Veneto Onlus, Venice, Italy; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Mohit Parekh
- Schepens Eye Research Institute of Mass Eye and Ear, Dept. of Ophthalmology, Harvard Medical School, Boston, MA, USA; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Matteo Airaldi
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Eye Clinic, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy; International Center for Ocular Physiopathology, Fondazione Banca Degli Occhi del Veneto Onlus, Venice, Italy; Schepens Eye Research Institute of Mass Eye and Ear, Dept. of Ophthalmology, Harvard Medical School, Boston, MA, USA; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy; Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Hannah J Levis
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy; Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Fondazione Banca Degli Occhi del Veneto Onlus, Venice, Italy; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Francesco Semeraro
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Eye Clinic, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, Fondazione Banca Degli Occhi del Veneto Onlus, Venice, Italy; Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
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Romano V, Passaro ML, Bachmann B, Baydoun L, Ni Dhubhghaill S, Dickman M, Levis HJ, Parekh M, Rodriguez-Calvo-De-Mora M, Costagliola C, Virgili G, Semeraro F. Combined or sequential DMEK in cases of cataract and Fuchs endothelial corneal dystrophy-A systematic review and meta-analysis. Acta Ophthalmol 2024; 102:e22-e30. [PMID: 37155336 DOI: 10.1111/aos.15691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/19/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed after phacoemulsification and intraocular lens (IOL) implantation (sequential DMEK) and DMEK combined with phacoemulsification and IOL implantation (combined DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and cataract. Systematic literature review and meta-analysis performed according to the PRISMA guidelines and registered in PROSPERO. Literature searches were conducted in Medline and Scopus. Comparative studies reporting sequential DMEK and combined DMEK in FECD patients were included. The main outcome measure of the study was the corrected distance visual acuity (CDVA) improvement. Secondary outcomes were postoperative endothelial cell density (ECD), rebubbling rate and primary graft failure rate. Bias risk was assessed and a quality appraisal of the body of evidence was completed using the Cochrane Robin-I tool. A total of 667 eyes (5 studies) were included in this review, 292 eyes (43.77%) underwent a combined DMEK, while 375 (56.22%) eyes underwent a sequential DMEK surgery. We found no evidence of a difference between the two groups (mean difference, 95% CI) regarding: (1) CDVA improvement (-0.06; -0.14, 0.03 LogMAR; 3 studies, I2 : 0%; p = 0.86); (2) postoperative ECD (-62; -190, 67 cells/mm2 ; 4 studies, I2 : 67%; p = 0.35); (3) rebubbling (risks ratio: 1.04; 0.59, 1.85; 4 studies, I2 : 48%; p = 0.89); and primary graft failure rate (risks ratio: 0.91; 0.32, 2.57; 3 studies, I2 : 0%; p = 0.86). Of all the 5 non-randomized studies, all (100%) were graded as low quality. The overall quality of the analysed studies was low. Randomized controlled trials are needed to confirm no difference or superiority of one approach in terms of CDVA, endothelial cell count and postoperative complication rate between the two arms.
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Affiliation(s)
- Vito Romano
- Ophthalmic Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Lombardy, Brescia, Italy
- Ophthalmic Unit, ASST Spedali Civili di Brescia, Lombardy, Brescia, Italy
| | - Maria Laura Passaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Bjoern Bachmann
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lamis Baydoun
- University Eye Hospital, Munster, Germany
- ELZA Institute Dietikon/Zurich, Zurich, Switzerland
| | - Sorcha Ni Dhubhghaill
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Ophthalmology, Visual Optics and Visual Rehabilitation, Department of Translational Neurosciences, University of Antwerp, Wilrijk, Belgium
| | - Mor Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Mohit Parekh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Massachusetts, Boston, USA
| | | | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Child Health, Ophthalmology, University of Florence-Careggi, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Francesco Semeraro
- Ophthalmic Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Lombardy, Brescia, Italy
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Romano D, Aiello F, Parekh M, Levis HJ, Gadhvi KA, Moramarco A, Viola P, Fontana L, Semeraro F, Romano V. Incidence and management of early postoperative complications in lamellar corneal transplantation. Graefes Arch Clin Exp Ophthalmol 2023; 261:3097-3111. [PMID: 37103622 PMCID: PMC10134734 DOI: 10.1007/s00417-023-06073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE To provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK). METHODS A literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review. RESULTS Complications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome. CONCLUSION It is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes.
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Affiliation(s)
- Davide Romano
- Ophthalmology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mohit Parekh
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kunal A Gadhvi
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Antonio Moramarco
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Pietro Viola
- Department of Ophthalmology, San Bartolo Hospital, Vicenza, Italy
| | - Luigi Fontana
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Semeraro
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Vito Romano
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy.
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Airaldi M, Zheng Y, Aiello F, Bachmann B, Baydoun L, Ní Dhubhghaill S, Dickman MM, Kaye SB, Fontana L, Gadhvi KA, Moramarco A, Rodriguez Calvo de Mora M, Rocha de Lossada C, Scorcia V, Viola P, Calza S, Levis HJ, Parekh M, Ruzza A, Ferrari S, Ponzin D, Semeraro F, Romano V. Preoperative surgeon evaluation of corneal endothelial status: the Viability Control of Human Endothelial Cells before Keratoplasty (V-CHECK) study protocol. BMJ Open Ophthalmol 2023; 8:e001361. [PMID: 37730252 PMCID: PMC10510883 DOI: 10.1136/bmjophth-2023-001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION The success of keratoplasty strongly depends on the health status of the transplanted endothelial cells. Donor corneal tissues are routinely screened for endothelial damage before shipment; however, surgical teams have currently no means of assessing the overall viability of corneal endothelium immediately prior to transplantation. The aim of this study is to validate a preoperative method of evaluating the endothelial health of donor corneal tissues, to assess the proportion of tissues deemed suitable for transplantation by the surgeons and to prospectively record the clinical outcomes of a cohort of patients undergoing keratoplasty in relation to preoperatively defined endothelial viability. METHODS AND ANALYSIS In this multicentre cohort study, consecutive patients undergoing keratoplasty (perforating keratoplasty, Descemet stripping automated endothelial keratoplasty (DSAEK), ultra-thin DSAEK (UT-DSAEK) or Descemet membrane endothelial keratoplasty) will be enrolled and followed-up for 1 year. Before transplantation, the endothelial viability of the donor corneal tissue will be evaluated preoperatively through trypan blue staining and custom image analysis to estimate the overall percentage of trypan blue-positive areas (TBPAs), a proxy of endothelial damage. Functional and structural outcomes at the end of the follow-up will be correlated with preoperatively assessed TBPA values. ETHICS AND DISSEMINATION The protocol will be reviewed by the ethical committees of participating centres, with the sponsor centre issuing the final definitive approval. The results will be disseminated on ClinicalTrials.gov, at national and international conferences, by partner patient groups and in open access, peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05847387.
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Affiliation(s)
- Matteo Airaldi
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Yalin Zheng
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Francesco Aiello
- Department of Experimental Medicine, Università degli Studi di Roma Tor Vergata, Roma, Italy
| | - Björn Bachmann
- Department of Ophthalmology, Uniklinik Köln, Koln, Germany
| | - Lamis Baydoun
- Department of Ophthalmology, Universitätsklinikum Münster, Munster, Germany
- ELZA Institute, Dietikon, Zurich, Switzerland
| | - Sorcha Ní Dhubhghaill
- Department of Translational Neurosciences, University Hospital Antwerp, Wilrijk, Belgium
- Department of Ophthalmology, University Hospital of Brussel, Jette, Belgium
| | - Mor M Dickman
- Eye Clinic, Maastricht UMC+, Maastricht, The Netherlands
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
| | - Stephen B Kaye
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Luigi Fontana
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Kunal A Gadhvi
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Marina Rodriguez Calvo de Mora
- Hospital Regional Universitario de Málaga, Málaga, Spain
- Qvision, VITHAS Almería, Almería, Spain
- Department of Ophthalmology, VITHAS Málaga, Málaga, Spain
| | - Carlos Rocha de Lossada
- Hospital Regional Universitario de Málaga, Málaga, Spain
- Qvision, VITHAS Almería, Almería, Spain
- Department of Ophthalmology, VITHAS Málaga, Málaga, Spain
- Surgery Department, Ophthalmology Area, University of Seville, Sevilla, Spain
| | - Vincenzo Scorcia
- Department of Medical and Surgical Sciences, Università degli Studi "Magna Græcia" di Catanzaro, Catanzaro, Italy
| | - Pietro Viola
- Ophthalmology Unit, Ospedale San Bortolo di Vicenza, Vicenza, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Hannah J Levis
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Mohit Parekh
- Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Diego Ponzin
- Fondazione Banca degli Occhi del Veneto, Venezia, Italy
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Università degli Studi di Brescia, Brescia, Italy
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Università degli Studi di Brescia, Brescia, Italy
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Simon S, Mount L, Moss S, Kaye SB, Levis HJ. P27-A149 Liverpool research eye biobank-our exerience of expanding to collect from living donors. BMJ Open Ophthalmol 2023; 8:A11-A12. [PMID: 37604541 DOI: 10.1136/bmjophth-2023-eeba.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
PURPOSE The Liverpool Research Eye Biobank (LREB) collects tissue for researchers who wish to study a wide range of ophthalmic conditions and develop new and more effective treatments. Historically the LREB has collected whole globes and conjunctiva from cadaveric donors but in 2021 we expanded to start collecting tissues from living donors who were undergoing ophthalmic surgery in the St Paul's Eye Unit in Liverpool. The aim was to provide tissue and fluid samples from patients with specific eye disease to research projects and create a bank of ophthalmic samples that can be provided to future research projects. Here we reflect on our experience after a year of collections. METHODS The clinical team discuss donation with patients during the pre-op appointment. Consent is taken on the day of surgery using an electronic consent form available on PENS. Samples are taken according to the patient's consent preference and then stored appropriately within a fridge/freezer close to theatre. Samples are then transferred for processing to the University of Liverpool (UoL). Fluids such as aqueous and vitreous are preserved at -80°C. The majority of ocular tissue collected is preserved by fixing in 10% neutral buffered formalin then transferred to 70% ethanol for long term storage. On request samples have been preserved using alternative methods such as snap freezing in liquid nitrogen. All samples are logged using a laboratory information management system. RESULTS Collections depend on the cooperation of the clinical teams and we have had very good engagement from them. The UoL works closely with St Pauls Eye Unit and the physical proximity between the two has been helpful. The location of the storage fridges close to theatre is important to limit extra effort for busy clinical teams. Regular training of consenters was key to ensure compliance with SOPs. In 11 months, we consented 419 donors and collected 673 samples including corneal tissue, iris, sclera, lens/capsule, retinal membranes, tenons, muscle, aqueous, vitreous, blood. CONCLUSION After the success of collections from one site we plan to expand to collect from multiple sites including Aintree and Alder Hey Children's Hospital.
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Romano V, Coco G, Levis HJ, Borgia A, Romano D, Pagano L, Virgili G, Kaye S. OP-8 Posterior stromal ripples increase risk of Descemet's membrane endothelial keratoplasty graft detachment worsening over time. BMJ Open Ophthalmol 2023; 8:A3. [PMID: 37493712 DOI: 10.1136/bmjophth-2023-bcm.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
*Correspondence, Vito Romano: vito.romano@gmail.com PURPOSE: To evaluate anterior segment optical coherence tomography (AS-OCT) features of Descemet's membrane endothelial keratoplasty (DMEK) grafts associated with graft attachment worsening over time. METHODS Retrospective case series on patients who received uncomplicated DMEK surgery and for whom subsequent AS-OCT data were available for analysis. Patients' demographics and surgical details were collected. AS-OCT was analysed for graft detachment axial extension, presence of posterior stromal ripples, quadrant involvement (location and number), degree of detachment extension, peripheral roll, presence and amount of air in the anterior chamber (AC). Features associated with re-bubbling and graft detachment worsening over time were identified. RESULTS A total of 147 patients with a mean age of 70.8±9.8 years (63% females) were included. AS-OCT was performed at 2.9±2.4 days after surgery. AS-OCT factors associated with re-bubbling were posterior stromal ripples (p=0.004) and detachment axial extension (p<0.001). At first follow-up, of the 147 DMEK, 67 showed complete attachment and 80 partial detachment. In those cases of initially completely attached grafts, posterior stromal ripples were associated with the risk of subsequent graft detachment (p=0.014) together with recipient age (p=0.043), phaco-combined surgery (p=0.018) and AS-OCT timing (p=0.033); while, in the initially partially detached grafts, detachment worsening was associated with posterior stromal ripples (p=0.025), detachment axial extension (p=0.003), degrees of detachment involvement (p=0.029), peripheral roll-in shape (p=0.033) and presence of air in the AC (p=0.032). Relative risk (RR) of graft detachment worsening in patients with moderate/severe posterior stromal ripples was 1.75 (95% CI =1.09-2.81). CONCLUSION Posterior stromal ripples and detachment axial extension >1/3 of graft surface area were the main risk factors for detachment worsening over time, and patients showing these features should be monitored closely to identify the need for re-bubbling at an early stage, thus improving surgical outcomes.
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Affiliation(s)
| | | | | | | | | | - Luca Pagano
- Royal Liverpool University Hospital, Liverpool, UK
| | | | - Stephen Kaye
- University of Liverpool, Liverpool, UK
- Royal Liverpool University Hospital, Liverpool, UK
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Coco G, Levis HJ, Borgia A, Romano D, Pagano L, Virgili G, Kaye SB, Romano V. Posterior stromal ripples increase risk of Descemet's membrane endothelial keratoplasty graft detachment worsening over time. Acta Ophthalmol 2023; 101:e205-e214. [PMID: 36120722 DOI: 10.1111/aos.15250] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/14/2022] [Accepted: 09/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate anterior segment optical coherence tomography (AS-OCT) features of Descemet's membrane endothelial keratoplasty (DMEK) grafts associated with graft attachment worsening over time. METHODS Retrospective case series on patients who received uncomplicated DMEK surgery and for whom subsequent AS-OCT data were available for analysis. Patients' demographics and surgical details were collected. AS-OCT was analysed for graft detachment axial extension, presence of posterior stromal ripples, quadrant involvement (location and number), degree of detachment extension, peripheral roll, presence and amount of air in the anterior chamber (AC). Features associated with re-bubbling and graft detachment worsening over time were identified. RESULTS A total of 147 patients with a mean age of 70.8 ± 9.8 years (63% females) were included. AS-OCT was performed at 2.9 ± 2.4 days after surgery. AS-OCT factors associated with re-bubbling were posterior stromal ripples (p = 0.004) and detachment axial extension (p < 0.001). At first follow-up, of the 147 DMEK, 67 showed complete attachment and 80 partial detachment. In those cases of initially completely attached grafts, posterior stromal ripples were associated with the risk of subsequent graft detachment (p = 0.014) together with recipient age (p = 0.043), phaco-combined surgery (p = 0.018) and AS-OCT timing (p = 0.033); while, in the initially partially detached grafts, detachment worsening was associated with posterior stromal ripples (p = 0.025), detachment axial extension (p = 0.003), degrees of detachment involvement (p = 0.029), peripheral roll-in shape (p = 0.033) and presence of air in the AC (p = 0.032). Relative risk (RR) of graft detachment worsening in patients with moderate/severe posterior stromal ripples was 1.75 (95% CI = 1.09-2.81). CONCLUSION Posterior stromal ripples and detachment axial extension >1/3 of graft surface area were the main risk factors for detachment worsening over time, and patients showing these features should be monitored closely to identify the need for re-bubbling at an early stage, thus improving surgical outcomes.
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Affiliation(s)
- Giulia Coco
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hannah J Levis
- Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Alfredo Borgia
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | - Davide Romano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | - Luca Pagano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), Ophthalmology Clinic, University of Firenze and AOU Careggi, Florence, Italy
| | - Stephen B Kaye
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Vito Romano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Instituto Universitario, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain.,Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy
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Fenech MT, Coco G, Pagano L, Gadhvi KA, Titley M, Levis HJ, Parekh M, Kaye SB, Romano V. Thinning rate over 24 months in ultrathin DSAEK. Eye (Lond) 2023; 37:655-659. [PMID: 35292772 PMCID: PMC9998379 DOI: 10.1038/s41433-022-02011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 11/08/2022] Open
Abstract
AIM To describe the changes in corneal graft thickness following ultrathin Descemet's Stripping Automated Endothelial Keratoplasty (UT-DSAEK) comparing pre- and postoperative values over a 24-month period. METHODS In this retrospective single-center case series, patients who received eye bank-prepared tissues for UT-DSAEK surgery were included. Preoperative and postoperative graft thickness measurements were determined in the eye bank and in clinic using anterior segment optical coherence tomography (AS-OCT) images. Graft thickness measurements and their percentage change between preoperative values and values at 1 day, 1 week and 1, 6, 12, 24 months were calculated. RESULTS In total, 47 eyes of 47 patients with a mean age of 69 ± 11 years (29 males) were included. Twnty-three patients had Fuchs' endothelial dystrophy (49%) and the remaining 24 had pseudophakic bullous keratopathy (51%). In total, 29/47 eyes underwent UT-DSAEK alone (62%) and 18/47 received combined cataract surgery as a triple procedure (38%). Preoperative donor graft thickness was 92 ± 28 μm. Compared to preoperative values, where graft thickness increased to 194 ± 101.3 μm at 1 day, 151.1 ± 71.4 μm at 1 week, and 108.4 ± 52.5 μm at 1 month. Graft thickness continued to gradually decrease over time until 6 months (91.7 ± 33.6 μm), and then plateaued at 12 months (83.9 ± 25.0 μm), showing minimal changes at 2 years (101.4 ± 37.5 μm). CONCLUSION Preoperative DSAEK graft thickness measurements as reported by the eye bank are a valid approximation of DSAEK graft thickness at 6 months after surgery and these measurements tend to stabilize over time up to 2 years after surgery.
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Affiliation(s)
- Matthew T Fenech
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
| | - Giulia Coco
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Pagano
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK.
- Humanitas Clinical and Research Center, via Manzoni 56, 20089, Rozzano, MI, Italy.
| | - Kunal A Gadhvi
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
| | - Mitchell Titley
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Mohit Parekh
- Institute of Ophthalmology, University College London, London, UK
| | - Stephen B Kaye
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Vito Romano
- Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Instituto Universitario, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
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Parekh M, Romano D, Wongvisavavit R, Coco G, Giannaccare G, Ferrari S, Rocha-de-Lossada C, Levis HJ, Semeraro F, Calvo-de-Mora MR, Scorcia V, Romano V. DMEK graft: One size does not fit all. Acta Ophthalmol 2023; 101:e14-e25. [PMID: 35751171 DOI: 10.1111/aos.15202] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023]
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is a popular procedure for the treatment of corneal endothelial diseases mainly targeting Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK). Although DMEK has multiple advantages, it is challenging in terms of graft preparation and delivery. One of the crucial factors of DMEK graft preparation is determining the size of the graft. Evaluating risks and benefits of transplanting larger or smaller grafts compared with the descemetorhexis performed following a standard DMEK procedure thus becomes important. Advanced techniques like pre-loaded DMEK requires pre-selection of graft diameter without physical examination of the eye making it more challenging. Therefore, recognizing the benefits of graft size and the number of transplanted endothelial cells becomes essential. Smaller DMEK grafts have been preferred and accepted for grafting. Larger diameter grafts have advantages but can be challenging due to higher detachment rates. We thus aim to review the challenges of preparing and delivering DMEK tissues with small or large diameter based on selected descemetorhexis area, discuss the outcomes based on different graft sizes, highlight related complications and suggest which cases may benefit from adopting smaller or larger graft size.
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Affiliation(s)
- Mohit Parekh
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Davide Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Rintra Wongvisavavit
- Institute of Ophthalmology, University College London, London, UK
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Giulia Coco
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almería, Spain
- Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Departamento de Cirugia, Area de Oftalmologia, Universidad de Sevilla, Sevilla, Spain
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Francesco Semeraro
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marina Rodríguez Calvo-de-Mora
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almería, Spain
- Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Ophthalmology Department, Hospital Regional Universitario, Málaga, Spain
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Barrera V, Joseph A, Romano V, Levis HJ, Hamill K, Kaye S, Rooney P. 29 Production of ultra-thin decellularised dermis to treat severe ocular diseases. BMJ Open Ophthalmol 2022; 7:A12-A13. [PMID: 37282682 DOI: 10.1136/bmjophth-2022-eeba.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION The ocular surface may be damaged by several ocular conditions such as chemical trauma, infection, neoplasia or autoimmune disease causing a loss of tissue and function leading to a painful loss of vision. Tissue regeneration is needed to re-establish homeostasis of the ocular surface and to preserve vision. Present replacement strategies have limitations ranging from availability of the same type of tissue to long-term stability. NHSBT currently produces decellularised dermis (DCD) for clinical allografting; comprising a "thin" (up to 1.0 mm) and a thick (>1.2 mm) DCD, used to treat non-healing leg ulcers or in rotator cuff repair. Even the thin DCD, however, is too thick for ophthalmic purposes. The objective of this study was to develop a new ultra-thin DCD for ocular allografting. MATERIALS AND METHODS Skin was retrieved, with consent for non-clinical use, from the back, front and back of the thighs of 3 different deceased donors, within 48 hours post-mortem. The tissue was cut into 5x5 cm squares and decellularised over 5 days as follows: decontamination with antimicrobials, de-epidermalisation (1M NaCl), hypotonic washes, detergent washes (with 0.01% SDS) and nuclease incubation. The DCD obtained was examined for integrity, handleability, residual remaining DNA and potential ultra-structural changes (by histology, DAPI and hematoxylin and eosin staining). RESULTS We obtained an intact ultra-thin DCD using the same standard GMP protocol, regularly used to decellularise skin for clinical use. Tissue handleability was comparable to amniotic membrane, as evaluated by the ophthalmic surgeons as well as tissue bank assistants. The mean thickness of the tissue was 0.25 mm (±0.11) at the end of processing (total N=18 samples from 3 donors). Histology confirmed successful removal of epithelial cells and integrity of the extracellular matrix. CONCLUSION We have successfully validated standard operating procedures for the production of ultra-thin DCD, in the attempt to obtain a valid alternative to amnion for the reconstruction of specific ocular regions (fornix, eye lids), where increased strength may be required. The thickness measurements at the end of processing suggest ultra-thin DCD obtained could represent a promising scaffold for regeneration of conjunctival tissue.
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Affiliation(s)
- Valentina Barrera
- NHS Blood and Transplant, Tissue and Eye Services Research and Development, Liverpool UK, Liverpool, UK
| | - Agatha Joseph
- NHS Blood and Transplant, Tissue and Eye Services Research and Development, Liverpool UK, Liverpool, UK
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kevin Hamill
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Stephen Kaye
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Paul Rooney
- NHS Blood and Transplant, Tissue and Eye Services Research and Development, Liverpool UK, Liverpool, UK
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Romano V, Ferrari S, Levis HJ, Parekh M. Editorial: Corneal transplantation and eye banking. Front Med (Lausanne) 2022; 9:983580. [PMID: 35935770 PMCID: PMC9349352 DOI: 10.3389/fmed.2022.983580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vito Romano
- Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Hannah J. Levis
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mohit Parekh
- Institute of Ophthalmology, University College London, London, United Kingdom
- *Correspondence: Mohit Parekh
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Pagano L, Shah H, Al Ibrahim O, Gadhvi KA, Coco G, Lee JW, Kaye SB, Levis HJ, Hamill KJ, Semeraro F, Romano V. Update on Suture Techniques in Corneal Transplantation: A Systematic Review. J Clin Med 2022; 11:1078. [PMID: 35207352 PMCID: PMC8877912 DOI: 10.3390/jcm11041078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
Effective suturing remains key to achieving successful outcomes in corneal surgery, especially anterior lamellar keratoplasty and full thickness transplantation. Limitations in the technique may result in complications such as wound leak, infection, or high astigmatism post corneal graft. By using a systematic approach, this study reviews articles and conducts content analysis based on update 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria). The aim of this paper is to summarize the state of the art of corneal suturing techniques for every type of corneal transplant and patient age and also their outcomes regarding astigmatism and complications. Future developments for corneal transplantation will be also discussed. This is important because especially the young surgeon must have knowledge of the implications of every suture performed in order to achieve consistent and predictable post-operative outcomes and also be aware of all the possible complications.
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Affiliation(s)
- Luca Pagano
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Haider Shah
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
| | - Omar Al Ibrahim
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, 25121 Brescia, Italy; (O.A.I.); (F.S.); (V.R.)
| | - Kunal A. Gadhvi
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
| | - Giulia Coco
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
| | - Jason W. Lee
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
- School of Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Stephen B. Kaye
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK; (H.J.L.); (K.J.H.)
| | - Hannah J. Levis
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK; (H.J.L.); (K.J.H.)
| | - Kevin J. Hamill
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK; (H.J.L.); (K.J.H.)
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, 25121 Brescia, Italy; (O.A.I.); (F.S.); (V.R.)
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, 25121 Brescia, Italy; (O.A.I.); (F.S.); (V.R.)
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK; (H.J.L.); (K.J.H.)
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13
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Romano V, Parekh M, Kazaili A, Steger B, Akhtar R, Ferrari S, Kaye SB, Levis HJ. Eye bank versus surgeon prepared Descemet stripping automated endothelial keratoplasty tissues: Influence on adhesion force in a pilot study. Indian J Ophthalmol 2022; 70:523-528. [PMID: 35086230 PMCID: PMC9023930 DOI: 10.4103/ijo.ijo_3637_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/06/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate and compare the biomechanical properties of the eye bank-prepared and surgeon prepared Descemet stripping automated endothelial keratoplasty (DSAEK) tissues. METHODS In this laboratory study, corneal tissues for research were randomly allocated in the following groups: a) surgeon-cut DSAEK and b) eye bank-prepared (pre-cut and pre-loaded) DSAEK. Endothelial cell loss (ECL), immunostaining for tight junction protein ZO-1, elastic modulus, and adhesion force were investigated. RESULTS ECL was not found to be significantly different between surgeon-cut DSAEK (7.8% ±6.5%), pre-cut DSAEK (8.6% ±2.3%), and pre-loaded DSAEK (11.1% ±4.8%) (P = 0.5910). ZO-1 was expressed equally across all groups. Surgeon-cut DSAEK grafts showed a significantly higher elastic modulus compared to pre-cut and pre-loaded DSAEK groups (P = 0.0047 and P < 0.0001, respectively). Adhesion force was significantly greater in the surgeon-cut DSAEK compared to pre-cut (P < 0.0001) or pre-loaded DSAEK groups (P = 0.0101). CONCLUSION The laboratory data on the biomechanics of DSAEK grafts suggests that surgeon-cut DSAEK grafts present higher elastic modulus and adhesion force compared to eye bank-prepared DSAEK grafts.
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Affiliation(s)
- Vito Romano
- St. Paul’s Eye Unit, Royal Liverpool University Hospital London, London, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool London, London, UK
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
| | - Mohit Parekh
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK
| | - Ahmed Kazaili
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool London, London, UK
- Department of Biomedical Engineering, College of Engineering, University of Babylon, Hillah, Iraq
- Babylon Health Directorate, Ministry of Health, Babylon, Iraq
| | - Bernhard Steger
- Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria
| | - Riaz Akhtar
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool London, London, UK
| | - Stefano Ferrari
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Stephen B Kaye
- St. Paul’s Eye Unit, Royal Liverpool University Hospital London, London, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool London, London, UK
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool London, London, UK
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Hidalgo-Alvarez V, Dhowre HS, Kingston OA, Sheridan CM, Levis HJ. Biofabrication of Artificial Stem Cell Niches in the Anterior Ocular Segment. Bioengineering (Basel) 2021; 8:135. [PMID: 34677208 PMCID: PMC8533470 DOI: 10.3390/bioengineering8100135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
The anterior segment of the eye is a complex set of structures that collectively act to maintain the integrity of the globe and direct light towards the posteriorly located retina. The eye is exposed to numerous physical and environmental insults such as infection, UV radiation, physical or chemical injuries. Loss of transparency to the cornea or lens (cataract) and dysfunctional regulation of intra ocular pressure (glaucoma) are leading causes of worldwide blindness. Whilst traditional therapeutic approaches can improve vision, their effect often fails to control the multiple pathological events that lead to long-term vision loss. Regenerative medicine approaches in the eye have already had success with ocular stem cell therapy and ex vivo production of cornea and conjunctival tissue for transplant recovering patients' vision. However, advancements are required to increase the efficacy of these as well as develop other ocular cell therapies. One of the most important challenges that determines the success of regenerative approaches is the preservation of the stem cell properties during expansion culture in vitro. To achieve this, the environment must provide the physical, chemical and biological factors that ensure the maintenance of their undifferentiated state, as well as their proliferative capacity. This is likely to be accomplished by replicating the natural stem cell niche in vitro. Due to the complex nature of the cell microenvironment, the creation of such artificial niches requires the use of bioengineering techniques which can replicate the physico-chemical properties and the dynamic cell-extracellular matrix interactions that maintain the stem cell phenotype. This review discusses the progress made in the replication of stem cell niches from the anterior ocular segment by using bioengineering approaches and their therapeutic implications.
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Affiliation(s)
- Veronica Hidalgo-Alvarez
- Institute of Biological Chemistry, Biophysics and Bioengineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Hala S. Dhowre
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; (H.S.D.); (O.A.K.)
| | - Olivia A. Kingston
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; (H.S.D.); (O.A.K.)
| | - Carl M. Sheridan
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; (H.S.D.); (O.A.K.)
| | - Hannah J. Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; (H.S.D.); (O.A.K.)
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Affiliation(s)
- Kunal A Gadhvi
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Giulia Coco
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Luca Pagano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Stephen B Kaye
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
- University of Liverpool, Department of Eye and Vision Science, Liverpool, United Kingdom
| | - Stefano Ferrari
- Fondazione Banca Degli Occhi Del Veneto Onlus, Venice, Italy; and
| | - Hannah J Levis
- University of Liverpool, Department of Eye and Vision Science, Liverpool, United Kingdom
| | - Mohit Parekh
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
- University of Liverpool, Department of Eye and Vision Science, Liverpool, United Kingdom
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16
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Pagano L, Gadhvi KA, Parekh M, Coco G, Levis HJ, Ponzin D, Ferrari S, Virgili G, Kaye SB, Edwards RT, Romano V. Cost analysis of eye bank versus surgeon prepared endothelial grafts. BMC Health Serv Res 2021; 21:801. [PMID: 34384422 PMCID: PMC8359056 DOI: 10.1186/s12913-021-06828-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Background Selective lamellar corneal transplantation (keratoplasty) has overtaken full thickness penetrating keratoplasty as the graft choice for endothelial failure. Even more recently eye bank prepared tissues are becoming increasing popular as a way to reduce the risks of tissue loss and stress during endothelial keratoplasty preparation in the surgical theatre. This study compares costs between surgeon and eye bank prepared tissues for Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). Methods Retrospective study conducted at the Royal Liverpool University Hospital including endothelial keratoplasties with a minimum of 6 months follow-up time. Cost analysis included surgical expenses, tissue acquisition fees, cost of patient’s ward admission and out-patient expenses, including cost of re-bubbling procedures, costs of visits, anterior segment imaging and optometrist visits within the first 6 months follow-up. Results Ninety-eight eyes of 98 patients were included in the study of which 42 underwent DSAEK surgery and 56 DMEK surgery. Cost analysis of surgical expenses in the DSAEK group showed a significant difference between using surgeon prepared and eye bank prepared tissue (£3866 ± 296 and £4389 ± 360, respectively; p < 0.01) and the same was found in the DMEK group (£3682 ± 167 and £4162 ± 167 for surgeon prepared and eye bank prepared tissues, respectively; p < 0.01). Cost of out-patient visits did not differ significantly in either group. Conclusions At the Royal Liverpool University Hospital, eye bank prepared tissues had higher surgical expenses compared to those prepared by the surgeon, while the post-operative care expenses were similar between the two groups.
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Affiliation(s)
- Luca Pagano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Kunal A Gadhvi
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Giulia Coco
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK
| | - Diego Ponzin
- International Center for Ocular Physiopathology, The Venice Eye Bank Foundation, Venice, Italy
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, The Venice Eye Bank Foundation, Venice, Italy
| | - Gianni Virgili
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Stephen B Kaye
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK
| | - Rhiannon T Edwards
- Department of Public Health, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. .,Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK. .,Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain. .,Department of Corneal and External Eye Diseases, St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot St, Liverpool, L7 8XP, UK.
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Pagano L, Gadhvi KA, Coco G, Fenech M, Titley M, Levis HJ, Ruzza A, Ferrari S, Kaye SB, Parekh M, Romano V. Rebubbling rate in preloaded versus surgeon prepared DSAEK. Eur J Ophthalmol 2021; 32:11206721211014380. [PMID: 33947232 DOI: 10.1177/11206721211014380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the clinical outcomes of eye bank preloaded Descemet stripping automated endothelial keratoplasty (DSAEK) grafts and surgeon prepared. METHODS In this retrospective study, the data were obtained from two groups (a) surgeon cut DSAEK where tissue was prepared by the surgeon immediately before surgery, and (b) preloaded DSAEK tissue shipped to the surgeon after preparation by the eye bank. Standard DSAEK preparations using Moria microkeratome with single pass method were performed. For the tissues prepared by the eye banks, they were preloaded in an iGlide device and shipped in transport media. Standard DSAEK surgery using bimanual pull-through technique was performed for all the grafts. Air was used as a tamponade. Main outcome measures included best corrected visual acuity (BCVA) and rebubbling rate. RESULT Out of 107 eyes of 101 patients that underwent DSAEK surgery, 33 tissues were prepared by the surgeon (sc-DSAEK), while 74 were prepared by the eye bank (pl-DSAEK). sc-DSAEK showed a rebubbling rate of 9.1%, compared to the 16.2% for the preloaded DSAEK (p = 0.11). There was no statistical difference in postoperative BCVA between the two groups. Logistic regression analysis showed no association between detachment rate and cataract surgery, graft preparation method, graft diameter and reason for graft. CONCLUSION Preloaded grafts have similar rebubbling rate and visual acuity achieved compared with surgeon prepared grafts.
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Affiliation(s)
- Luca Pagano
- The Royal Liverpool University Hospital, Liverpool, UK
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Giulia Coco
- The Royal Liverpool University Hospital, Liverpool, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Mitchell Titley
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Stefano Ferrari
- Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Stephen B Kaye
- The Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Vito Romano
- The Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
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Ruzza A, Parekh M, Avoni L, Wojcik G, Ferrari S, Desneux L, Ponzin D, Levis HJ, Romano V. Ultra-thin DSAEK using an innovative artificial anterior chamber pressuriser: a proof-of-concept study. Graefes Arch Clin Exp Ophthalmol 2021; 259:1871-1877. [PMID: 33907884 DOI: 10.1007/s00417-021-05194-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report the impact of establishing and maintaining a high intracameral pressure (ICP) of 200 mmHg on UT-DSAEK graft preparation using an artificial anterior chamber pressuriser (ACP) control unit (Moria SA, Antony, France). METHOD Retrospective laboratory and clinical study. Four paired donor corneas were mounted on an artificial anterior chamber and subjected to 70 mmHg ("low") and 200 mmHg ("high") ICP using an ACP system. The central corneal thinning rate was measured after 5 min using AS-OCT and the endothelial cell viability was analysed using trypan blue and live/dead staining following 70 mmHg and 200 mmHg ICP. Visual outcomes and complications in a clinical case series of nine patients with bullous keratopathy who underwent UT-DSAEK using 200 mmHg ICP during graft preparation are reported. RESULTS Laboratory outcomes showed 2 ± 1% and 2 ± 2% dead cells following 70 mmHg and 200 mmHg ICP respectively. Percentage viability in the 70 mmHg group (52.94 ± 5.88%) was not found to be significantly different (p = 0.7) compared to the 200 mmHg group (59.14 ± 10.43%). The mean corneal thinning rate after applying 200 mmHg ICP was 27 ± 13 μm/min centrally (7.2%/min). In the clinical case series, two cases were combined with cataract surgery. Re-bubbling rate was 11%. At the last follow-up (259 ± 109 days), graft thickness was 83 ± 22 μm centrally, endothelial cell density was 1175 ± 566 cell/mm2 and the BCVA of 0.08 ± 0.12 logMAR was recorded with no episodes of rejection. CONCLUSION ACP control unit for UT-DSAEK graft preparation helps in consistently obtaining UT-DSAEK grafts without compromising endothelial cell viability.
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Affiliation(s)
- Alessandro Ruzza
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy.
| | - Mohit Parekh
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy
- Institute of Ophthalmology, University College London, London, UK
| | - Luca Avoni
- Unita Operativa Oculistica Di Ravenna, Azienda USL Della Romagna, Emilia Romagna, Italy
| | - Gabriela Wojcik
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy
| | - Stefano Ferrari
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy
| | | | - Diego Ponzin
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy
| | - Hannah J Levis
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
- Department of Ophthalmology, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion on Oftalmologica, Oviedo, Spain
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19
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Parekh M, Romano V, Hassanin K, Testa V, Wongvisavavit R, Ferrari S, Haneef A, Willoughby C, Ponzin D, Jhanji V, Sharma N, Daniels J, Kaye SB, Ahmad S, Levis HJ. Biomaterials for corneal endothelial cell culture and tissue engineering. J Tissue Eng 2021; 12:2041731421990536. [PMID: 33643603 PMCID: PMC7894589 DOI: 10.1177/2041731421990536] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022] Open
Abstract
The corneal endothelium is the posterior monolayer of cells that are responsible for maintaining overall transparency of the avascular corneal tissue via pump function. These cells are non-regenerative in vivo and therefore, approximately 40% of corneal transplants undertaken worldwide are a result of damage or dysfunction of endothelial cells. The number of available corneal donor tissues is limited worldwide, hence, cultivation of human corneal endothelial cells (hCECs) in vitro has been attempted in order to produce tissue engineered corneal endothelial grafts. Researchers have attempted to recreate the current gold standard treatment of replacing the endothelial layer with accompanying Descemet's membrane or a small portion of stroma as support with tissue engineering strategies using various substrates of both biologically derived and synthetic origin. Here we review the potential biomaterials that are currently in development to support the transplantation of a cultured monolayer of hCECs.
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Affiliation(s)
- Mohit Parekh
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London, London, UK.,International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool Broadgreen University Hospital, Liverpool, UK.,Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion on Oftalmologica, Oviedo, Spain.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Kareem Hassanin
- St. Paul's Eye Unit, Royal Liverpool Broadgreen University Hospital, Liverpool, UK
| | - Valeria Testa
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Rintra Wongvisavavit
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London, London, UK.,HRH Princess Chulabhorn College of Medical Sciences, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Atikah Haneef
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Colin Willoughby
- School of biomedical sciences, University of Ulster, Belfast, UK
| | - Diego Ponzin
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Julie Daniels
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London, London, UK
| | - Stephen B Kaye
- St. Paul's Eye Unit, Royal Liverpool Broadgreen University Hospital, Liverpool, UK
| | - Sajjad Ahmad
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital NHS Trust Foundation, London, UK
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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20
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Romano V, Kazaili A, Pagano L, Gadhvi KA, Titley M, Steger B, Fernández-Vega-Cueto L, Meana A, Merayo-Lloves J, Diego P, Akhtar R, Levis HJ, Ferrari S, Kaye SB, Parekh M. Eye bank versus surgeon prepared DMEK tissues: influence on adhesion and re-bubbling rate. Br J Ophthalmol 2020; 106:177-183. [PMID: 33127828 PMCID: PMC8788033 DOI: 10.1136/bjophthalmol-2020-317608] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/22/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022]
Abstract
Aim To investigate the difference in adhesion and rebubbling rate between eye bank and surgeon prepared Descemet membrane endothelial keratoplasty (DMEK) tissues. Methods Laboratory and clinical retrospective comparative interventional case series. Research corneal tissues were obtained for laboratory investigation. The clinical study involved patients with endothelial dysfunction who underwent DMEK surgery and tamponade with air. Tissues were stripped using a standard DMEK stripping technique (SCUBA) and shipped as prestripped or loaded in a 2.2 intra-ocular lens cartridge with endothelium facing inwards (preloaded) before transporting from the eye bank to the surgeon. For surgeon prepared tissues, all the grafts were stripped in the theatre and transplanted or stripped in the laboratory and tested immediately. Adhesion force and elastic modulus were measured in the centre and mid-periphery in a laboratory ex vivo investigation using atomic force microscopy, while rebubbling rates were recorded in the clinical study. Results There was no difference in endothelial cell viability between surgeon or eye bank prepared tissue. Surgeon-stripped DMEK grafts in the laboratory investigation showed significantly higher elastic modulus and adhesion force compared to prestripped and preloaded tissues (p<0.0001). In the clinical data, rebubbling rates of 48%, 40% and 15% were observed in preloaded, prestripped and surgeon-stripped DMEK grafts, respectively. Rebubbling rates were significantly associated with combined cataract surgery (p=0.009) and with time from harvesting the graft to the surgery (p=0.02). Conclusions Decreased adhesion forces and elastic modulus in eye bank prepared tissues may contribute to increased rebubbling rates.
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Affiliation(s)
- Vito Romano
- Instituto Universitario, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain .,Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Ahmed Kazaili
- Department of Biomedical Engineering, College of Engineering, University of Babylon, Hillah, Iraq.,Babylon Health Directorate, Ministry of Health, Babylon, Iraq.,Department of Mechanical, Materials and Aerospace Engineering, University of Liverpool School of Engineering, Liverpool, UK
| | - Luca Pagano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Mitchell Titley
- Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Bernhard Steger
- Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luis Fernández-Vega-Cueto
- Instituto Universitario, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
| | - Alvaro Meana
- Instituto Universitario, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
| | - Jesus Merayo-Lloves
- Instituto Universitario, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
| | - Ponzin Diego
- International Centre for Ocular Physiopathology, Fondazione Banca Degli Occhi del Veneto, Venezia Zelarino, Italy
| | - Riaz Akhtar
- Department of Mechanical, Materials and Aerospace Engineering, University of Liverpool School of Engineering, Liverpool, UK
| | - Hannah J Levis
- Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Stefano Ferrari
- International Centre for Ocular Physiopathology, Fondazione Banca Degli Occhi del Veneto, Venezia Zelarino, Italy
| | - Stephen B Kaye
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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21
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Romano V, Pagano L, Gadhvi KA, Coco G, Titley M, Fenech MT, Ferrari S, Levis HJ, Parekh M, Kaye S. Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK. BMJ Open Ophthalmol 2020; 5:e000546. [PMID: 33094167 PMCID: PMC7569929 DOI: 10.1136/bmjophth-2020-000546] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To compare clinical outcomes and complications between pre-loaded ultra-thin Descemet stripping automated endothelialkeratoplasty (pl-UT-DSAEK) and pre-loaded Descemet membrane endothelial keratoplasty (pl-DMEK). Methods and analysis Comparative study in patients with endothelial dysfunction associated with Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy who underwent pl-UT-DSAEK or pl-DMEK transplants. For both groups, the tissues were pre-loaded at the Fondazione Banca degli Occhi del Veneto (Venice, Italy) and shipped to The Royal Liverpool University Hospital (Liverpool, UK). Best corrected visual acuity (BCVA) and re-bubbling rates were the main outcome measures. Results 56 eyes of 56 patients were included. 31 received pl-UT-DSAEK and 25 received pl-DMEK. At 12 months, BCVA (LogMAR) was significantly better for pl-DMEK (0.17±0.20 LogMAR) compared with pl-UT-DSAEK (0.37±0.37 LogMAR, p<0.01). The percentage of people that achieved ≥20/30 was significantly higher in the pl-DMEK group. The rate of re-bubbling, however, was significantly higher for pl-DMEK (44.0%) than for Pl-UT-DSAEK (12.9%), p<0.01. Conclusion Pl-DMEK offers better BCVA than pl-UT-DSAEK. The higher re-bubbling rate associated with pre-loaded DMEK is of concern.
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Affiliation(s)
- Vito Romano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
| | - Luca Pagano
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Ophthalmology, Humanitas Research Hospital, Milan, Italy
| | - Kunal A Gadhvi
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | - Giulia Coco
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Ophthalmology, Universita degli Studi di Roma Tor Vergata, Roma, Italy
| | - Mitchell Titley
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Hannah J Levis
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Mohit Parekh
- Institute of Ophthalmology, University College London, London, UK
| | - Stephen Kaye
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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22
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Eyre JJ, Williams RL, Levis HJ. A human retinal microvascular endothelial-pericyte co-culture model to study diabetic retinopathy in vitro. Exp Eye Res 2020; 201:108293. [PMID: 33039459 DOI: 10.1016/j.exer.2020.108293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
This human primary co-culture model using human retinal microvascular endothelial cells (hREC) and human retinal pericyte cells (hRP) aims to improve current understanding of the cellular changes occurring in the retinal microvasculature during diabetic retinopathy (DR). Currently, patients often present in clinic with late-stage DR, only when vision becomes impaired. Therefore, new strategies for earlier detection in clinic, combined with novel pharmaceutical and cellular interventions are essential in order to slow or halt the progression of DR from background to sight-threatening stage. This co-culture model can be used as a simple, replicable in vitro tool to discover and assess novel drug therapies and improve fundamental understanding of alterations to cell behaviour in the human retinal microvasculature during DR. hRP and hREC were cultured for up to 21 days in normoxic (20%) or hypoxic (2%) oxygen levels and physiological (5.5 mM) or very high (33 mM) glucose, to maintain a healthy, or induce a diabetic-like phenotype in vitro. Mono- or co-cultured hREC and hRP were seeded 1:1 in healthy (20% oxygen and 5.5 mM glucose) or diabetic-like (2% oxygen and 33 mM glucose) conditions, on either side of untreated polyethylene terephthalate (PET) transwell inserts, and cultured for 21 days. Mono- and co-cultures were analysed for changes in metabolic activity, angiogenic response and junctional protein expression, using immunofluorescence antibody labelling, flow cytometry and multiplex ELISA technology. hRP and hREC were successfully co-cultured, and the glucose and oxygen concentrations selected for the in vitro healthy and diabetic-like conditions were sufficient for cell viability and EC monolayer integrity, with evidence of an angiogenic response in diabetic-like conditions within the 21 day timeframe. Angiopoietin-2 (Ang-2), vascular endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) secretion were all increased, whilst hepatocyte growth factor (hHGF), tissue inhibitor for metalloproteinase-2 (TIMP-2) and interleukin-8 (IL-8) secretion were all reduced in the in vitro diabetic-like conditions. The secretion profile of co-cultures was different to mono-cultures, highlighting the importance of using co-culture models to collect data more reflective of the close relationship between hRP-hREC in vivo. Previous groups have developed useful co-culture models utilising non-human, immortalised or large vessel-sourced cells to explore changes to the vasculature during hypoxia and/or high glucose insult. In this study the use of human primary, retina-specific microvascular cells, mono- and co-cultured, collected over a longer culture period, has enabled detection of changes that may have been missed in previous models.
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Affiliation(s)
- Jessica J Eyre
- Department of Eye and Vision Science, Institute of Life Course & Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby St, Liverpool, United Kingdom.
| | - Rachel L Williams
- Department of Eye and Vision Science, Institute of Life Course & Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby St, Liverpool, United Kingdom.
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course & Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby St, Liverpool, United Kingdom.
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23
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Abstract
PURPOSE To describe a method to visualize and manage a completely detached Descemet membrane endothelial keratoplasty (DMEK) tissue scroll in the anterior chamber. METHODS A 56-year-old male patient with pseudophakic bullous keratopathy, who underwent uncomplicated DMEK surgery, had a complete graft detachment diagnosed at 1-week follow-up. The graft was reattached using a new technique, that is, the free-floating graft was stained in the anterior chamber with trypan blue, immediately followed by air injection to separate the host stroma from the dye. The stained DMEK graft was opened by gentle tapping and attached to the host stroma by air tamponade. RESULT This technique allowed sufficient staining of DMEK tissue to further evaluate and correct the graft orientation inside the anterior chamber without compromising the stroma. The DMEK graft was attached 1 week after the reattachment procedure. The cornea cleared confirming the functionality of the endothelial cells. CONCLUSIONS The technique described may be useful in the cases of complete detachment of DMEK tissue and poor visualization of the DMEK tissue orientation. Staining with trypan blue under a "protective" air bubble can provide sufficient visualization to ensure the unfolding of DMEK tissue and reduce the risk of host stromal staining.
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Affiliation(s)
- Nardine Menassa
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; and
| | - Luca Pagano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; and
| | - Kunal A Gadhvi
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; and
| | - Giulia Coco
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; and
| | - Stephen B Kaye
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; and.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; and.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
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24
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Kennedy S, Lace R, Carserides C, Gallagher AG, Wellings DA, Williams RL, Levis HJ. Poly-ε-lysine based hydrogels as synthetic substrates for the expansion of corneal endothelial cells for transplantation. J Mater Sci Mater Med 2019; 30:102. [PMID: 31485761 PMCID: PMC6726667 DOI: 10.1007/s10856-019-6303-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Abstract
Dysfunction of the corneal endothelium (CE) resulting from progressive cell loss leads to corneal oedema and significant visual impairment. Current treatments rely upon donor allogeneic tissue to replace the damaged CE. A donor cornea shortage necessitates the development of biomaterials, enabling in vitro expansion of corneal endothelial cells (CECs). This study investigated the use of a synthetic peptide hydrogel using poly-ε-lysine (pεK), cross-linked with octanedioic-acid as a potential substrate for CECs expansion and CE grafts. PεK hydrogel properties were optimised to produce a substrate which was thin, transparent, porous and robust. A human corneal endothelial cell line (HCEC-12) attached and grew on pεK hydrogels as confluent monolayers after 7 days, whereas primary porcine CECs (pCECs) detached from the pεK hydrogel. Pre-adsorption of collagen I, collagen IV and fibronectin to the pεK hydrogel increased pCEC adhesion at 24 h and confluent monolayers formed at 7 days. Minimal cell adhesion was observed with pre-adsorbed laminin, chondroitin sulphate or commercial FNC coating mix (fibronectin, collagen and albumin). Functionalisation of the pεK hydrogel with synthetic cell binding peptide H-Gly-Gly-Arg-Gly-Asp-Gly-Gly-OH (RGD) or α2β1 integrin recognition sequence H-Asp-Gly-Glu-Ala-OH (DGEA) resulted in enhanced pCEC adhesion with the RGD peptide only. pCECs grown in culture at 5 weeks on RGD pεK hydrogels showed zonula occludins 1 staining for tight junctions and expression of sodium-potassium adenosine triphosphase, suggesting a functional CE. These results demonstrate the pεK hydrogel can be tailored through covalent binding of RGD to provide a surface for CEC attachment and growth. Thus, providing a synthetic substrate with a therapeutic application for the expansion of allogenic CECs and replacement of damaged CE.
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Affiliation(s)
- Stephnie Kennedy
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Rebecca Lace
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Constandinos Carserides
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Andrew G Gallagher
- SpheriTech Ltd, Business and Technical Park, The Heath, Runcorn, WA7 4QX, UK
| | - Donald A Wellings
- SpheriTech Ltd, Business and Technical Park, The Heath, Runcorn, WA7 4QX, UK
| | - Rachel L Williams
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK
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25
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Parekh M, Borroni D, Ruzza A, Levis HJ, Ferrari S, Ponzin D, Romano V. A comparative study on different Descemet membrane endothelial keratoplasty graft preparation techniques. Acta Ophthalmol 2018. [PMID: 29520992 DOI: 10.1111/aos.13746] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare different Descemet membrane endothelial keratoplasty (DMEK) graft preparation methods. METHODS Stripping from the trabecular meshwork (M1) using epithelial spatula; stripping by scoring the peripheral endothelium (M2) using Sinskey hook; stripping by punch method (M3) using donor trephine; Submerged hydro-separation (M4); and pneumatic dissection method (M5) were evaluated. Preparation time, costs, endothelial cell loss (ECL) postpreparation, cell death and morphology were compared. Hoechst/Ethidium/Calcien AM (HEC) staining and Zonula Occludens-1 (ZO-1) expression were analysed. Statistical analysis was performed using one-way anova and; Tukey as post hoc test. RESULTS A total of 35 corneas (seven per group) were used. Endothelial cell loss (ECL) represented as Mean (SD), in M1, M2, M3, M4 and M5 was 2.7 (5.0), 3.0 (7.4), 1.2 (7.4), 3.3 (7.3) and 4.1 (7.1)%, respectively not showing any difference between the groups (p = 0.96). A significantly higher cell death (p < 0.05) was observed in M4 and M5 compared with M1, M2 and M3. Graft preparation time was significantly shorter in M4 and M5 and longest in M3 (p < 0.05). M3 was the most expensive preparation technique. Minimum pleomorphic cells were observed in M1, M2 and M3, whereas moderate pleomorphism was seen in M4 and M5. Hoechst, Ethidium homodimer and Calcein AM (HEC) staining showed high Ethidium positivity (dead cells) in M4 and M5 with minimum positivity in M1, M2 and M3. Zonula Occludens-1 (ZO-1) was expressed in all the conditions except the denuded areas. CONCLUSION Graft preparation using Sinskey hook (M2) and donor punch (M3) are reliable methods in terms of efficiency and quality with acceptable range of ECL. The preparation time and associated costs could be a limitation for M3.
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Affiliation(s)
- Mohit Parekh
- International Center for Ocular Physiopathology; The Veneto Eye Bank Foundation; Venice Italy
| | - Davide Borroni
- Department of Ophthalmology; Riga Stradins University; Riga Latvia
- Department of Genetics; Riga Stradins University; Riga Latvia
| | - Alessandro Ruzza
- International Center for Ocular Physiopathology; The Veneto Eye Bank Foundation; Venice Italy
| | - Hannah J Levis
- Department of Eye and Vision Science; Institute of Ageing and Chronic Disease; University of Liverpool; Liverpool UK
| | - Stefano Ferrari
- International Center for Ocular Physiopathology; The Veneto Eye Bank Foundation; Venice Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology; The Veneto Eye Bank Foundation; Venice Italy
| | - Vito Romano
- Corneal and External Eye Service; St. Paul's Eye Unit; Royal Liverpool University Hospital; Liverpool UK
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26
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Zarouchlioti C, Sanchez-Pintado B, Hafford Tear NJ, Klein P, Liskova P, Dulla K, Semo M, Vugler AA, Muthusamy K, Dudakova L, Levis HJ, Skalicka P, Hysi P, Cheetham ME, Tuft SJ, Adamson P, Hardcastle AJ, Davidson AE. Antisense Therapy for a Common Corneal Dystrophy Ameliorates TCF4 Repeat Expansion-Mediated Toxicity. Am J Hum Genet 2018; 102:528-539. [PMID: 29526280 PMCID: PMC5985359 DOI: 10.1016/j.ajhg.2018.02.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/14/2018] [Indexed: 12/12/2022] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is a common disease for which corneal transplantation is the only treatment option in advanced stages, and alternative treatment strategies are urgently required. Expansion (≥50 copies) of a non-coding trinucleotide repeat in TCF4 confers >76-fold risk for FECD in our large cohort of affected individuals. An FECD subject-derived corneal endothelial cell (CEC) model was developed to probe disease mechanism and investigate therapeutic approaches. The CEC model demonstrated that the repeat expansion leads to nuclear RNA foci, with the sequestration of splicing factor proteins (MBNL1 and MBNL2) to the foci and altered mRNA processing. Antisense oligonucleotide (ASO) treatment led to a significant reduction in the incidence of nuclear foci, MBNL1 recruitment to the foci, and downstream aberrant splicing events, suggesting functional rescue. This proof-of-concept study highlights the potential of a targeted ASO therapy to treat the accessible and tractable corneal tissue affected by this repeat expansion-mediated disease.
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Affiliation(s)
| | | | | | - Pontus Klein
- ProQR Therapeutics, Zernikedreef 9, 2333 CK Leiden, the Netherlands
| | - Petra Liskova
- Research Unit for Rare Diseases, Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, Prague 128 08, Czech Republic; Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, U nemocnice 2, Prague, Czech Republic
| | - Kalyan Dulla
- ProQR Therapeutics, Zernikedreef 9, 2333 CK Leiden, the Netherlands
| | - Ma'ayan Semo
- UCL Institute of Ophthalmology, London ECIV 9EL, UK
| | | | - Kirithika Muthusamy
- UCL Institute of Ophthalmology, London ECIV 9EL, UK; Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Lubica Dudakova
- Research Unit for Rare Diseases, Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, Prague 128 08, Czech Republic
| | - Hannah J Levis
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool L7 8TX, UK
| | - Pavlina Skalicka
- Research Unit for Rare Diseases, Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, Prague 128 08, Czech Republic; Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, U nemocnice 2, Prague, Czech Republic
| | - Pirro Hysi
- Department of Ophthalmology and Twin Research, King's College London, London SE1 7EH, UK
| | | | - Stephen J Tuft
- UCL Institute of Ophthalmology, London ECIV 9EL, UK; Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Peter Adamson
- ProQR Therapeutics, Zernikedreef 9, 2333 CK Leiden, the Netherlands
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Romano V, Parekh M, Ruzza A, Willoughby CE, Ferrari S, Ponzin D, Kaye SB, Levis HJ. Comparison of preservation and transportation protocols for preloaded Descemet membrane endothelial keratoplasty. Br J Ophthalmol 2017; 102:549-555. [PMID: 29133296 PMCID: PMC5890643 DOI: 10.1136/bjophthalmol-2017-310906] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/06/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
Abstract
Background/aims Descemet membrane endothelial keratoplasty (DMEK) preparation is technically demanding and is a limiting factor for uptake of this kind of surgery. Supply methods that simplify the procedure for surgeons are key to increasing uptake. This study compares two different shipping protocols for DMEK. Methods An 8.5 mm DMEK graft was punched, marked and loaded for transportation in two different conditions: (A) endothelium trifolded inwards in organ culture conditions (n=7) and (B) endothelium rolled outwards in hypothermic conditions (n=7). Tissues were shipped from Italy to the UK, then analysed for orientation, endothelial cell density, denuded areas, cell mortality, triple viability staining (Hoechst/ethidium homodimer/calcein AM (HEC)), immunolocalisation of ZO-1 and Na/K-ATPase proteins, visualisation of actin filaments using phalloidin and histological analysis using H&E on paraffin-embedded sections. Results All tissues clearly showed the mark used for graft orientation. After shipping in condition A, there was an increase in cell mortality of 8.1% and in denuded areas of 22.4%, whereas for condition B there was an increase in cell mortality of 14.2% and in denuded areas of 34.3% after shipping. HEC staining revealed areas of viable cells and apoptotic cells, with large denuded areas found in the periphery for condition B and within folds for condition A. Conclusions Prestripped preloaded DMEK grafts retained sufficient viable cells for transplantation, with condition A (endothelium-in) offering the advantage of greater flexibility of use due to a longer shelf-life. HEC analysis provides further detailed information as to the status of DMEK grafts and should be used in future similar studies.
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Affiliation(s)
- Vito Romano
- Department of Ophthalmology, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion on Oftalmologica, Oviedo, Spain
| | - Mohit Parekh
- International Center for Ocular Physiopathology, Veneto Eye Bank Foundation, Venice, Italy
| | - Alessandro Ruzza
- International Center for Ocular Physiopathology, Veneto Eye Bank Foundation, Venice, Italy
| | - Colin E Willoughby
- Department of Ophthalmology, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, University of Liverpool Institute of Ageing and Chronic Disease, Liverpool, UK
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Veneto Eye Bank Foundation, Venice, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, Veneto Eye Bank Foundation, Venice, Italy
| | - Stephen B Kaye
- Department of Ophthalmology, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, University of Liverpool Institute of Ageing and Chronic Disease, Liverpool, UK
| | - Hannah J Levis
- Department of Eye and Vision Science, University of Liverpool Institute of Ageing and Chronic Disease, Liverpool, UK
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Abstract
PURPOSE Creation of an in vitro model incorporating specific features that characterize a particular stem niche would allow researchers to study stem cell behavior in a more physiological environment. MATERIALS AND METHODS We have developed a tissue engineering process (RAFT) that rapidly and reliably creates bioengineered limbal crypts (BLCs) in the surface of collagen-based tissue equivalents (TEs). These BLCs mimic the three-dimensional topography of the limbal crypts (LCs), located in the limbal region of the human cornea, which are home to a population of limbal epithelial stem cells (LESCs). RESULTS Human limbal epithelial (hLE) cells occupying our BLCs expressed putative LESC markers such as ΔNp63α and Bmi1 and produced basement membrane proteins such as laminin β1 and laminin γ3; expression patterns are very similar to those seen in native LCs. Human limbal stromal cells elongate and align along the edge of native LCs and in our RAFT TEs, human limbal fibroblasts (hLFs) also appeared to exhibit this alignment and elongation behavior in response to the BLC topography. CONCLUSIONS We have demonstrated that we can maintain an immature population of hLE cells and aligned stromal cells in our BLCs to mimic some elements of the complexity of the human LESC niche.
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Affiliation(s)
- Hannah J Levis
- a Department of Ocular Biology and Therapeutics , UCL Institute of Ophthalmology , London , UK
| | - Julie T Daniels
- a Department of Ocular Biology and Therapeutics , UCL Institute of Ophthalmology , London , UK
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29
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Massie I, Dziasko M, Kureshi A, Levis HJ, Morgan L, Neale M, Sheth R, Tovell VE, Vernon AJ, Funderburgh JL, Daniels JT. Advanced imaging and tissue engineering of the human limbal epithelial stem cell niche. Methods Mol Biol 2015; 1235:179-202. [PMID: 25388395 DOI: 10.1007/978-1-4939-1785-3_15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The limbal epithelial stem cell niche provides a unique, physically protective environment in which limbal epithelial stem cells reside in close proximity with accessory cell types and their secreted factors. The use of advanced imaging techniques is described to visualize the niche in three dimensions in native human corneal tissue. In addition, a protocol is provided for the isolation and culture of three different cell types, including human limbal epithelial stem cells from the limbal niche of human donor tissue. Finally, the process of incorporating these cells within plastic compressed collagen constructs to form a tissue-engineered corneal limbus is described and how immunohistochemical techniques may be applied to characterize cell phenotype therein.
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Affiliation(s)
- Isobel Massie
- Department of Ocular Biology and Therapeutics, Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
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Massie I, Levis HJ, Daniels JT. Response of human limbal epithelial cells to wounding on 3D RAFT tissue equivalents: effect of airlifting and human limbal fibroblasts. Exp Eye Res 2014; 127:196-205. [PMID: 25108221 DOI: 10.1016/j.exer.2014.07.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/25/2014] [Accepted: 07/29/2014] [Indexed: 12/13/2022]
Abstract
Limbal epithelial stem cell deficiency can cause blindness but may be treated by human limbal epithelial cell (hLE) transplantation, normally on human amniotic membrane. Clinical outcomes using amnion can be unreliable and so we have developed an alternative tissue equivalent (TE), RAFT (Real Architecture for 3D Tissue), which supports hLE expansion, and stratification when airlifted. Human limbal fibroblasts (hLF) may be incorporated into RAFT TEs, where they support overlying hLE and improve phenotype. However, the impact of neither airlifting nor hLF on hLE function has been investigated. hLE on RAFT TEs (±hLF and airlifting) were wounded using heptanol and re-epithelialisation (fluorescein diacetate staining), and percentage putative stem cell marker p63α and proliferative marker Ki67 expression (wholemount immunohistochemistry), measured. Airlifted, hLF- RAFT TEs were unable to close the wound and p63α expression was 7 ± 0.2% after wounding. Conversely, non-airlifted, hLF- RAFT TEs closed the wound within 9 days and p63α expression was higher at 22 ± 5% (p < 0.01). hLE on both hLF- and hLF+ RAFT TEs (non-airlifted) closed the wound and p63α expression was 26 ± 8% and 36 ± 3% respectively (ns). Ki67 expression by hLE increased from 1.3 ± 0.5% before wounding to 7.89 ± 2.53% post-wounding for hLF- RAFT TEs (p < 0.01), and 0.8 ± 0.08% to 17.68 ± 10.88% for hLF+ RAFT TEs (p < 0.05), suggesting that re-epithelialisation was a result of proliferation. These data suggest that neither airlifting nor hLF are necessarily required to maintain a functional epithelium on RAFT TEs, thus simplifying and shortening the production process. This is important when working towards clinical application of regenerative medicine products.
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Affiliation(s)
- Isobel Massie
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK.
| | - Hannah J Levis
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK.
| | - Julie T Daniels
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK.
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Shortt AJ, Bunce C, Levis HJ, Blows P, Doré CJ, Vernon A, Secker GA, Tuft SJ, Daniels JT. Three-year outcomes of cultured limbal epithelial allografts in aniridia and Stevens-Johnson syndrome evaluated using the Clinical Outcome Assessment in Surgical Trials assessment tool. Stem Cells Transl Med 2014; 3:265-75. [PMID: 24443006 DOI: 10.5966/sctm.2013-0025] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Limbal stem cell deficiency (LSCD) is an eye disorder in which the stem cells responsible for forming the surface skin of the cornea are destroyed by disease. This results in pain, loss of vision, and a cosmetically unpleasant appearance. Many new treatments, including stem cell therapies, are emerging for the treatment of this condition, but assessment of these new technologies is severely hampered by the lack of biomarkers for this disease or validated tools for assessing its severity. The aims of this study were to design and test the reliability of a tool for grading LSCD, to define a set of core outcome measures for use in evaluating treatments for this condition, and to demonstrate their utility. This was achieved by using our defined outcome set (which included the Clinical Outcome Assessment in Surgical Trials of Limbal stem cell deficiency [COASTL] tool) to evaluate the 3-year outcomes for allogeneic ex vivo cultivated limbal epithelial transplantation (allo-CLET) in patients who had bilateral total LSCD secondary to aniridia or Stevens-Johnson syndrome. The results demonstrate that our new grading tool for LSCD, the COASTL tool, is reliable and repeatable, and that improvements in the biomarkers used in this tool correlate positively with improvements in visual acuity. The COASTL tool showed that following allo-CLET there was a decrease in LSCD severity and an increase in visual acuity up to 12 months post-treatment, but thereafter LSCD severity and visual acuity progressively deteriorated.
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Affiliation(s)
- Alex J Shortt
- Cells for Sight Transplantation and Research Programme and Ocular Biology and Therapeutics Division, University College London Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London Clinical Trials Unit, London, United Kingdom
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Levis HJ, Massie I, Dziasko MA, Kaasi A, Daniels JT. Rapid tissue engineering of biomimetic human corneal limbal crypts with 3D niche architecture. Biomaterials 2013; 34:8860-8. [PMID: 23968855 DOI: 10.1016/j.biomaterials.2013.08.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/01/2013] [Indexed: 02/06/2023]
Abstract
Limbal epithelial stem cells are responsible for the maintenance of the human corneal epithelium and these cells reside in a specialised stem cell niche. They are located at the base of limbal crypts, in a physically protected microenvironment in close proximity to a variety of neighbouring niche cells. Design and recreation of elements of various stem cell niches have allowed researchers to simplify aspects of these complex microenvironments for further study in vitro. We have developed a method to rapidly and reproducibly create bioengineered limbal crypts (BLCs) in a collagen construct using a simple one-step method. Liquid is removed from collagen hydrogels using hydrophilic porous absorbers (HPAs) that have custom moulded micro-ridges on the base. The resulting topography on the surface of the thin collagen constructs resembles the dimensions of the stromal crypts of the human limbus. Human limbal epithelial cells seeded onto the surface of the constructs populate these BLCs and form numerous layers with a high proportion of the cells lining the crypts expressing putative stem cell marker, p63α. The HPAs are produced using a moulding process that is flexible and can be adapted depending on the requirements of the end user. Creation of defined topographical features using this process could be applicable to numerous tissue-engineering applications where varied 3-dimensional niche architectures are required.
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Affiliation(s)
- Hannah J Levis
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK.
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33
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Levis HJ, Peh GSL, Toh KP, Poh R, Shortt AJ, Drake RAL, Mehta JS, Daniels JT. Plastic compressed collagen as a novel carrier for expanded human corneal endothelial cells for transplantation. PLoS One 2012; 7:e50993. [PMID: 23226443 PMCID: PMC3511456 DOI: 10.1371/journal.pone.0050993] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 10/29/2012] [Indexed: 01/13/2023] Open
Abstract
Current treatments for reversible blindness caused by corneal endothelial cell failure involve replacing the failed endothelium with donor tissue using a one donor-one recipient strategy. Due to the increasing pressure of a worldwide donor cornea shortage there has been considerable interest in developing alternative strategies to treat endothelial disorders using expanded cell replacement therapy. Protocols have been developed which allow successful expansion of endothelial cells in vitro but this approach requires a supporting material that would allow easy transfer of cells to the recipient. We describe the first use of plastic compressed collagen as a highly effective, novel carrier for human corneal endothelial cells. A human corneal endothelial cell line and primary human corneal endothelial cells retained their characteristic cobblestone morphology and expression of tight junction protein ZO-1 and pump protein Na+/K+ ATPase α1 after culture on collagen constructs for up to 14 days. Additionally, ultrastructural analysis suggested a well-integrated endothelial layer with tightly opposed cells and apical microvilli. Plastic compressed collagen is a superior biomaterial in terms of its speed and ease of production and its ability to be manipulated in a clinically relevant manner without breakage. This method provides expanded endothelial cells with a substrate that could be suitable for transplantation allowing one donor cornea to potentially treat multiple patients.
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Affiliation(s)
- Hannah J Levis
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, London, UK.
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Levis HJ, Menzel-Severing J, Drake RAL, Daniels JT. Plastic compressed collagen constructs for ocular cell culture and transplantation: a new and improved technique of confined fluid loss. Curr Eye Res 2012; 38:41-52. [PMID: 23016925 DOI: 10.3109/02713683.2012.725799] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Cultured limbal epithelial cell transplantation is a commonly used clinical treatment for ocular surface repair. We have previously shown that plastic compressed (PC) type I collagen constructs are a suitable substrate for human limbal epithelial cell (HLEC) culture for transplantation. For this process to achieve compliance with Good Manufacturing Practice, and therefore be suitable for therapeutic cell therapy manufacture, the original method required substantial modification. METHODS The compression method was changed from unconfined (highly variable reproducibility) to confined compression (CC) (highly reproducible manufacture) and we assessed whether this altered the physical characteristics of the substrate. We have measured transparency, assessed scanning electron microscope images of the surface and performed live/dead cell viability assays of cells within the constructs. HLECs were then cultured on the surface of both types of construct and the resulting cell phenotype characterized. RESULTS We have determined that the change in process does not alter the physical characteristics of the substrate. Furthermore, there is no change to the substrate's ability to support HLEC culture and maintenance of a mixed population of stem and differentiated cells. Additionally, cells were able to form a confluent sheet and multilayer to produce an intact epithelium. CONCLUSIONS This modification allows scaling up of the process in a well-plate format, which is essential for creation of multiple corneal epithelial models for in vitro testing. This improvement to the original plastic compression method also allows the process to be employed in custom-made cassettes, the design of which takes into consideration the manufacturing and regulatory requirements for delivery of a cell therapy.
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Affiliation(s)
- Hannah J Levis
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, Bath Street, London, UK.
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35
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Levis HJ, Brown RA, Daniels JT. Plastic compressed collagen as a biomimetic substrate for human limbal epithelial cell culture. Biomaterials 2010; 31:7726-37. [PMID: 20674002 DOI: 10.1016/j.biomaterials.2010.07.012] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/04/2010] [Indexed: 11/17/2022]
Abstract
We describe, for the first time, the use of cellular plastic compressed collagen as a substrate for human limbal epithelial cell expansion and stratification. The characteristics of expanded limbal epithelial cells on either acellular collagen constructs or those containing human limbal fibroblasts were compared to a human central cornea control. After compression, human fibroblasts in collagen constructs remained viable and limbal epithelial cells were successfully expanded on the surface. After airlifting, a multilayered epithelium formed with epithelial cell morphology very similar to that of cells in the central cornea. Immunochemical staining revealed expression of basement membrane proteins and differentiated epithelial cell markers found in native central cornea. Ultrastructural analysis revealed cells on collagen constructs had many features similar to central cornea, including polygonal, tightly opposed surface epithelial cells with microvilli and numerous desmosomes at cell-cell junctions. Taken together, these data demonstrate that plastic compressed collagen constructs can form the basis of a biomimetic tissue model for in vitro testing and could potentially provide a suitable alternative to amniotic membrane as a substrate for limbal epithelial cell transplantation.
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Affiliation(s)
- Hannah J Levis
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, London, UK.
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36
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Notara M, Alatza A, Gilfillan J, Harris AR, Levis HJ, Schrader S, Vernon A, Daniels JT. In sickness and in health: Corneal epithelial stem cell biology, pathology and therapy. Exp Eye Res 2010; 90:188-95. [PMID: 19840786 DOI: 10.1016/j.exer.2009.09.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 09/30/2009] [Indexed: 12/12/2022]
Affiliation(s)
- M Notara
- Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, Cells for Sight Transplantation & Research Programme, 11-43 Bath Street, London EC1V 9EL, UK.
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