Ocular surface diseases include several blinding disorders
that affect the cornea and conjunctiva at the front surface
of the eye. As a national referral centre, Moorfields has
relatively large numbers of patients whose ocular surface
disease is so severe that they have lost their sight.
Moorfields Eye Hospital and the UCL Institute of Ophthalmology
have a long track record in the investigation of ocular
surface disorders. We have focussed on diseases
that result in the dysfunction and death of limbal
epithelial cells that can lead to chronic corneal
ulceration.
Direct molecular quality enhancement
of donor corneas
We aim to prolong the lifespan of donor cornea
cells following transplantation in patients with
blinding corneal disease (about 500 corneal
transplants are undertaken in Moorfields each
year).
We are developing a method to do this
by modifying donor cornea cells in the laboratory
before transplanting them into patients’ eyes.
This should reduce – and possibly remove – the
need to replace transplants and, in the future,
the need for a transplant may be eliminated
altogether by treating the patient’s own cornea
with this type of technique.
Stem cell transplantation for limbal failure
The Cells for Sight Transplantation and Research
Programme is at the forefront of using stem cells
to tackle eye diseases that were previously
untreatable. Where previously permanent
blindness occurred, we can now help some
patients with genetic disorders, eye inflammation
or chemical burns who have scarring and opacity
of the cornea.
We are developing the optimum
process to provide a graft with the highest possible
stem cell content. Successfully transferring such a graft from the laboratory to the surface of a
patient’s eye in the operating theatre has been an
obstacle that we are overcoming by developing a
novel bioengineered substance to carry the cells.
If the disease occurs in both eyes, stem cells from
a patient’s own eyes cannot be used and we have
previously had to rely on donor tissue. However,
we have now developed methods of isolating stem
cells from a variety of human tissues, such as the
mouth, and hair follicles from the scalp, to provide
a source of cells that will regenerate the surface of
the eye but will not be a target for immune rejection.
Treating blinding scarring conjunctival
diseases by selective new treatments
Blinding scarring conjunctival diseases are
immune-mediated – they result from abnormal
activity of the body’s immune system. We are
currently investigating the genetics and specific
proteins in the ocular surface that are the targets
for the immune response. At present, very potent
immunosuppression drugs are necessary to stop
disease progressing in most patients and we are
evaluating new drugs and drug combinations that
are more effective but also more specific, in order
to reduce the incapacitating or life-threatening
side-effects of the drugs in current use.