Corneal Epithelial Autograft With Middle Lamellar Keratoplasty for Severe Ocular Burns

Study Overview
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Brief Summary
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The purpose of this pilot study is to explore whether corneal epithelial autograft (EA) combined with allogeneic middle lamellar keratoplasty (AMLK) is more effective than limbal autograft (LA) with AMLK for ocular surface reconstruction in patients with severe ocular burns.

Official Title
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A Clinical Trial of Corneal Epithelial Autograft Combined With Allogeneic Middle Lamellar Keratoplasty for Patients With Severe Ocular Burns

Conditions
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Ocular Burns

Intervention / Treatment
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* Procedure: EA and AMLK
* Procedure: LA and AMLK


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Unilateral severe ocular burns with more than half limbal stem cells deficiency (LSCD). The history of the disease is at least 12 months at the time of screening visit. Presence of superficial neo-vascularization affecting at least 2 cornea quadrants and involving central cornea. Informed consent signed by a patient or legal guardian, or having the ability to comply with study assessments for the full duration of the study. Exclusion Criteria: LSCD of mild degree, with less than 2 quadrants of neo-vessel invasion and without central cornea involvement. LSCD by ocular surface disorders other than ocular burns. Eyelids malposition. The center corneal thickness<450µm, the depth of corneal opacity<150µm or the full corneal lamellar opacity. High myopia with a spherical equivalent of -15.0 D or less. Corneal or ocular surface infection within 30 days prior to study entry. Ocular surface malignancy. Uncontrolled diabetes with most recent HgA1c greater than 8.5%. Renal failure with creatinine clearance ≤ 25mL/min per 1.73 m2. Alanine aminotransferase > 40IU/L, or aspartate aminotransferase > 40IU/L. Platelet levels < 150,000 or > 450,000 per microliter. Hemoglobin < 12.0 g/dL (male) or < 11.0 g/dL (female); Prothrombin time > 16s and activated partial thrombin time > 35s in patients not accepting anticoagulant therapy; An international normalized ratio greater than 3 in patients accepting anticoagulant therapy. Pregnancy (positive test) or lactation. Participation in another simultaneous medical investigation or clinical trial. Severe cicatricial eye disease; Conjunctival scarring with fornix shortening. Ocular comorbidities that affect the prognosis of transplantation, such as advanced glaucoma or retinal diseases. Severe dry eye disease as determined by Schirmer's test < 2mm at least in one eye. Any medical or social condition that in the judgment of the investigator would interfere with or serve as a contraindication to adherence to the study protocol or ability to give informed consent. Signs of current infection, including fever and treatment with antibiotics. Active immunological diseases. History of anti-glaucoma surgeries.

Ages Eligible for Study
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Minimum Age: 4 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EA and AMLK<br>Corneal epithelial autograft (EA) combined with allogeneic middle lamellar keratoplasty (AMLK) is used for the treatment of patients with severe ocular burns. | Procedure: EA and AMLK<br>* A 7-9mm diameter corneal epithelial tissue will be obtained from the fellow eye using femtosecond laser technology. This epithelial autograft (EA) is then ready for transplantation on the disease eye, following the procedure of allogeneic middle lamellar keratoplasty (AMLK).<br>|
| Active Comparator: LA and AMLK<br>Limbal autograft (LA) combined with AMLK is used for the treatment of patients with severe ocular burns. | Procedure: LA and AMLK<br>* A 3-clock-hour limbal autograft (LA) will be obtained from the fellow eye. This is then ready for transplantation on the disease eye following the procedure of AMLK.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Success rate of corneal reepithelialization in disease eyes. | The percentage of patients with completely epithelized and avascular corneal surface in disease eyes. | 12 months |