# Corneal surface reconstruction for the chemical injured eye by transplanting autologous cultivated limbal epithelial sheet “Nepic®”

## TL;DR

This paper reports a case where a corneal surface was successfully reconstructed using an autologous cultivated limbal epithelial sheet called Nepic® for a patient with limbal stem cell deficiency.

## Contribution

The paper contributes a clinical case study demonstrating the use of Nepic® for corneal reconstruction in a real-world scenario.

## Key findings

- The patient's corneal surface appeared smooth and shiny 7 months after CLET with Nepic®.
- Graft rejection occurred after initial allo-corneal grafting, necessitating a second procedure.
- Handling the cultivated epithelial sheet on the ring-shaped holder is essential for successful transplantation.

## Abstract

“Nepic®” (Japan Tissue Engineering Co., Ltd., Gamagori, Japan) is an autologous cultivated limbal epithelial sheet, approved in 2020 in Japan for the reconstruction of the corneal surface in cases of limbal stem cell deficiency (LSCD). Because the surgical procedure known as cultivated limbal epithelial cell sheet transplantation (CLET) has only recently been introduced and the number of cases remains limited, accumulating clinical experience is essential to ensure the safety and success of this procedure. Herein, we report the clinical course of a patient with unilateral LSCD who underwent CLET for a corneal surface reconstruction using Nepic®.

A 50-year-old man sustained bilateral eye injuries from mortar during construction work. The patient’s right cornea exhibited LSCD. Initial treatment involved a 360° limbal transplantation with an allo-corneal graft at a university hospital. However, graft rejection occurred, and the corneal surface was subsequently covered by conjunctival tissue within 2 months. Because the patient’s left cornea and conjunctiva appeared healthy, we performed CLET with Nepic® 3 years after the limbal transplantation.

When using Nepic®, it is essential to become accustomed to handling the cultivated epithelial sheet on the ring-shaped holder; however, cultivated corneal epithelium transplantation can also be performed without the carrier material, but rather as a sheet. Though the corneal surface appeared smooth and shiny at 7 months postoperatively, we seek to determine whether the epithelial cells on the patient’s cornea are of corneal or conjunctival origin without resorting to invasive procedures, such as biopsy.