Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Ex-vivo Expansion of Limbal Epithelial Stem Cells on Intact Amniotic Membrane as a New Therapeutic Approach in Recurrent Pterygium. A Case Report

Wüstemeyer H., Hernandez Galindo E. E., Steuhl K.-P., Meller D. 
Dept. of Ophthalmology, University of Essen

Purpose: The pterygium is a degenerative and hyperplastic disease which leads to a degeneration of Bowman’s layer and disturbs the integrity and barrier function of the limbal epithelial cell population. Hence, a focal or partial limbal stem cell deficiency is induced. An increased UV exposure has been discussed as a crucial factor in the pathogenesis of the pterygium. A 73 year-old patient presented with a highly inflamed, twice recurrent pterygium of the left eye extending 6 hours of the nasal limbal circumference. Excision of pterygium had been performed twice unsuccessfully before. In the right eye a recurrence occurred after the first pterygium surgery.
Method: The risk of developing an iatrogenic limbal stem cell deficiency by using conventional autologous limbal transplantation was in this case high due to the massive extension of the recurrent pterygium. Therefore, we decided to perform ex-vivo expansion of limbal stem cells from a small limbal biopsy (1*2mm). Ex-vivo expansion was done on intact amniotic membrane using SHEM as culture media and autologous serum (5%). Two weeks later, the pterygium was completely removed. The amniotic membrane with the expanded limbal epithelial stem cells was placed on the created defect. A second amniotic membrane was used as a protective patch.

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