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Corneal epithelial stem cells restore vision in some blind patients when transplanted - Japan study.

Transplantation of corneal epithelial stem cells can restore useful vision to many patients blinded by severe ocular-surface damage, according to result published in the June 3rd issue of The New England Journal of Medicine. Kazuo Tsubota, MD of Tokyo Dental College in Chiba, Japan and colleagues evaluated 70 stem cell transplants from cadaveric eyes into 43 eyes of 39 patients with severe ocular-surface disorders and followed them for an average of 3 years. According to the report, 22 of the 43 eyes (51%) had corneal epithelialization after transplantation. Of those 22 eyes, 7 had corneal stromal edema, and 15 (35%) had completely clear corneas.

"Visual acuity improved by 2 or more lines on the acuity chart in 26 eyes (60%)," the authors wrote. "Mean visual acuity improved from counting fingers to vision sufficient to distinguish the largest symbol on the visual acuity chart from a distance of 1 meter. The 15 eyes in which the corneas became clear had a final mean visual acuity of 0.11 (the ability to distinguish the largest eye chart symbol from a distance of 5 meters)." This improvement, the researchers said, allowed the patients to perform daily activities and increased their self-sufficiency.

The most serious complication after surgery was ocular hypertension, which developed in 16 eyes. Other problems included persistent defects in the corneal epithelium in 26 eyes, all but 2 of which eventually healed, and graft rejection in 13 of 28 eyes.

In an accompanying editorial, Edward Holland, MD and Gary Schwartz, MD of the University of Minnesota in Minneapolis noted that though "these results may appear unimpressive" to those not in the field, "without epithelial transplantation, none of these patients would have had clear corneas. All would be functionally blind." And while almost half of those with severe ocular-surface disease will not have much improvement after epithelial stem cell transplantation, Holland and Schwartz said the Tsubota's "encouraging results...provide a basis for further progress."
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Publication:Transplant News
Date:Jun 30, 1999
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