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Ask Dr. A.S. Desai Your Own Question
Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2405
Experience:  MS Ophthalmology with 13 years of surgical expereince
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I suffered a chemical in one eye in 2004. As a result I have

Resolved Question:

I suffered a chemical in one eye in 2004. As a result I have a limbal stem cell deficiency. I see that an italian named Rama is doing limbal stem cell cultures and transplanting back to the injured eye. Is this treatment viable in your opinion? What is the success rate? What down sides are there? Why are not more doctors and hospitals doing this? Are there any doctors in America doing it? What advice do you have about this?
Submitted: 5 years ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 5 years ago.

Dr. A.S. Desai :

Hello, Welcome to Just Answer

Dr. A.S. Desai :

Are you available for chat now?

Customer:

yes

Dr. A.S. Desai :

Limbal stem cell transplantation is being done all over the world now and I'm sure most of the major eye hospitals in the US are doing a lot of work in this regard.

Dr. A.S. Desai :

Where do you reside in the US?

Customer:

The American doctors I talked to, several of them, do transplants by taking a large swath of the healthy eye. They tell me that it puts the healthy eye at risk. I am therefore looking at the culture method that only takes a biopsy size sample with little risk to the healthy eye. However, my web searches are only showing one hit, the doctor in italy, Rama.

Customer:

I live in California, near San Francisco.

Dr. A.S. Desai :

Have you tried at a university teaching hospital which are usually well epquiped for the latest surgical procedures. You are right about taking a fairly large chunk of the limbal cells from the healthy contralateral eye for transplantation. But the amount of tissue needed would depend on the area of limbal ischemia in the affected eye.

Customer:

I recently saw a specialist at Stanford U, and he only offered the standard method that you are talking about. Unfortunately, doctors in america generally do not elaborate on what are the options, and it is common that they withhold info i.e. for the good of the patient? Anyway, I found Rama's article on line. What, if anything, can you tell me about culturing and limbal stem cells as a treatment option?

Dr. A.S. Desai :

Unfortunately you right bang on. Generally speaking, limbal stem cell transplantation is the ideal treatment modality for chemical injury to the eye with limbal ischemia. The limbal stem cells have a natural capability to multiply and grow at the site of transplantation thus recreating the lost tissue without compromising on the cellular nature. You are already aware of the advantages of cultured limbal stem cell transplantation over the routine transplant, due to the small amount of tissue which would be needed here. I do not reside in the US and thus unable to give you names of doctors who actually do this procedure. But I am aware that there is a teaching university hospital in California and I do feel that this must be one of the research projects there, in the department of ophthalmology.

Customer:

You are probably aware that treatment options in america are severely limited by non-technical issues, the FDA, politicians, patents, political payoffs. As such, I am considering going outside the country. Is this treatment available in India, or better yet, Costa Rica, or elsewhere besides Italy?

Dr. A.S. Desai :

Sorry but could give the exact data that you were probably looking for but maybe you could look at this site for some more info- http://www.uclahealth.org/body.cfm?id=307&action=detail&ref=19, if they could explain the details of the procedure done there, it would be helpful to you. From one of my co-experts, I came to know that it is one of good teaching hospitals around.

Dr. A.S. Desai :

I know that this procedure is done in India at one of the premier eye institutes- LVPrasad eye institue, Hyderabad.

Dr. A.S. Desai :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693999/ you can read in detail about their work here.

Dr. A.S. Desai :

But lot of articles show that outside of US, this procedure is also done at Belgium( Antwerp) as part of their research work- http://clinicaltrials.gov/ct2/show/NCT00845117

Dr. A.S. Desai :

University of Navarra, spain is also doing research in this field- http://www.basqueresearch.com/berria_irakurri.asp?Berri_Kod=3834&hizk=I

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