Stem Cell Transplantation in Ophthalmology

Radhika Tandon Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi.
The role of stem cells in repair and restoration of body tissues is increasingly being recognised as a powerful tool in the armamentarium of the medical community. The All India Institute of Medical Sciences has been a leader in this field in the country and the world in this field. The Ophthalmology department of AIIMS at the Dr Rajendra Prasad Centre for Ophthalmic Sciences has been actively involved in work related to stem cell transplantation in the eye ever since the concept was developed internationally. The first clinical application was for diseases related to the cornea, but recently the service has been extended to treat retinal degenerations in collaboration with the department of Biochemistry, AIIMS and the Institute Rotary Cancer Hospital, IRCH, AIIMS. The first stem cell transplant for limbal stem cell deficiency in the eye was done in 1993 at R P Centre. Stem cell transplantation for this condition has been done using donor lenticules from eye donors either allografts from cadaver donors or from a living relative in bilateral cases or autografts by harvesting stem cells from the other health eye for unilateral diseases. A new technique of combined stem cell and lamellar corneal graft has also been successfully developed and established in the centre for the treatment of cases of chemical burns with excess cor neal thinning where simple stem cell transplantation would not be adequate to rehabilitate the eye. Recently the centre has also successfully harvested stem cells from the limbus of cadaver donors and other eye of unilaterally affected patients, expanded the stem cells in the laboratory and successfully transplanted them in needy patients. This technique has been done at several centres in the world, but our significant contribution has been to successfully demonstrate that simple modifications can help to reduce costs and bring this technology within reach of poor and needy patients in developing countries. Since the service for stem cell transplantation was established in R P Centre a total of 457 patients have been operated by various surgeons in the centre for different stem cell deficiency diseases mostly related to chemical injuries . This includes 350 using lenticule technique, 50 using large diameter lamellar keratoplasty technique, 5 using cultured limbal stem cells. Preliminary results of an on-going prospective randomised trial indicate that living related limbal stem cell transplantation is better in our conditions compared to cadaveric stem cells vis a vis the restoration of the ocular surface. Comparative evaluation of systemic versus topical cyclosporin after allogenic stem cell transplantation is underway. In addition based on their neurotrophic and vasculotrophic effects a phase 1 clinical trial of using autologous bone marrow stem cells for retinitis pigmentosa and dry age related macular degeneration has been started. So far 4 patients have been operated by intravitreal injection of stem cells prepared from autologous bone marrow with no adverse effects. The Stem Cell Facility in R P Centre is inclusive of the following departments and their collaborators. Cornea and Refractive Surgery Services, National Eye Bank, Ocular Phar macolo g y, Ocular Microbiology, R P Centre for Ophthalmic Sciences; Biochemistry Department, IRCH; Stem Scell Facility, AIIMS Professor Rasik Vajpayee, Head of Unit III, Professor Jeewan S Titiyal (Unit III) Professor Radhika Tandon (Unit III) Principal Investigator Stem Cell Culture Project, Dr Namrata Sharma (Unit III), Prof Anita Panda, Head of Unit IV, Professor Sudershan Khokhar (Unit IV); Professor Atul Kumar Principal Investigator Retinal Degeneration Project; Professor Gita Satpathy, Ocular Micribiology; Dr Velapandian, Ocular Pharmacology; Professor Neeta Singh, Department of Biochemistry, AIIMS; Professor Lalit Kumar, IRCH and Dr Sujata Mohanty, Stem Cell Facility, AIIMS