الفهرس 
Severe Ocular Surface DiseaseOnly 14 pages are availabe for public view
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Abstract
The technique of cultivating corneal epithelium on AM provided healthy epithelial sheets that were transplanted successfully onto of the eyes of patients with LSCD. This procedure relieved symptoms, reduced inflammation, improved the condition of the ocular surface, and increased vision.
The main conditions that cause limbal stem cell deficiency are chemical and thermal burns, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, contact lens related trauma, and iatrogenic causes such as repeated surgery.
The clinical features of stem cell deficiency, from mild to severe, include the loss of limbal anatomy, irregular, thin epithelium, stippled fluorescein staining of the area covered by abnormal epithelium, unstable tear film, filaments and erosions, superficial and deep vascularisation, persistent epithelial defects leading to ulceration, melting and perforation, fibrovascular pannus, scarring, keratinisation and calcification.
Transplantation of in vitro–cultivated limbal epithelium is recently developed to reduce the risk to the donor eye. The advantage of this method is that a small (1 mm) limbal piece has to be removed from the donor eye. Different techniques are used to culture the tissue for transplantation. There are two main methods of producing ex vivo cultured 43،epithelial cells for transplantation, the explants culture system and the suspension culture system Moreover, CLET provided a better environment for a subsequent keratoplasty and perhaps a better chance of corneal graft survival. However, the success rate of this procedure depended on the extent of previous ocular damage, especially lid abnormalities and corneal stromal destruction, and on postoperative complications. This procedure is a straightforward and useful treatment for patients with LSCD, especially in cases with adequate tear flow and normal eyelids. However, for those with severe ocular surface destruction or uncorrectable lid deformities, keratoprosthesis might be a better treatment option.
Co-culture of feeder cells with epithelial cells is shown to be beneficial for epithelial cell proliferation and stratification. Although the exact mechanism has not been fully elucidated, the 3T3 fibroblast culture system is successfully applied in the limbal epithelial cell culture.
Also, preparation of autologus oral and nasal mucosa graft shows promising results. Amniotic membrane promotes expansion of remaining limbal epithelial stem cells. The use of fibrin glue brings in several benefits. A microkeratome-based limbal harvester for stem cell transplantation is proposed, which utilizes technology similar to that used in making flaps for LASIK procedures