Eyeworld

SPRING 2025 | EYEWORLD | 79 C designed to take advantage of Descemet's membrane's resistance to degradation despite breakdown of other parts of the cornea. The other major discovery, he said, is that this mem- brane has proteins that are found in the limbal niche but not found in the central cornea so these can act like a limbal niche, ideally keeping stem cells alive long term. He said laboratory data has demonstrated this, and it has been compared to amniotic membrane. "You can grow limbal stem cells on BrightMEM, and they form a stratified layer of cornea, with layers of mature epithelium, just like the normal eye would, but the very bottom layer still express- es the markers for limbal stem cells, so we're creating this reservoir on the ocular surface of stem cells," Mr. Shukla said. For patients with persistent epithelial defects, there is an over- whelmed stem cell population and a sick ocular surface because the limbal stem cells can't keep up with maintaining the clear epithelium. Mr. Shukla mentioned a pilot clinical study in humans that, to date, has had 14 completed cases. In that study, patients with congenital aniridia, a genetic disorder of the eye associated with limbal stem cell deficiency, were enrolled for treatment. Fifty-seven percent of patients had neovascularization in the central cornea degrading their vision. All patients underwent transplantation of a BrightMEM allograft. The intention was to evaluate whether BrightMEM could augment the remaining limbal stem cell population on the ocular surface in these patients, prevent neovascularization, and re- habilitate vision long term. Interim results at 6 months were favorable, with all patients healed and no recurrence of central neovascularization. In addition, all of the patients who were candi- dates wanted to have their second eye done. Mr. Shukla also discussed how the prod- uct could be used for ocular pain, as it has the potential to provide immediate pain relief from postop day 1. The thought of using it for this application came about when BrightMEM was given to a patient who had ocular toxicity associated with a new cancer drug for end-stage cervical cancer. The pain from the ocular toxic- ity was debilitating, and with limited options, the surgeon used BrightMEM. Within days after the procedure in her first eye, the pain was completely gone. The surgeon soon treated the second eye in the same way with similar results. According to Dr. Cheung, the BrightMEM procedure initially involves a keratectomy where irregular epithelium and anterior corneal scarring is removed from the cornea to create a bed for the BrightMEM. The BrightMEM is continued on page 80 This is a 77-year-old white female with partial limbal stem cell deficiency of unknown etiology treated with BrightMEM anterior keratoplasty. Preoperatively (left), the patient had superficial neovascularization and pannus from 8 o'clock to 6 o'clock involving the central visual axis. Postoperative month 4 (right), there was no recurrent neovascularization. Source: Joshua Hou, MD

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