Contemporary limbal stem cell transplantation - a review

Area of Science:

• Ophthalmology
• Regenerative Medicine
• Transplantation Immunology

Background:

• Limbal stem cell deficiency (LSCD) is characterized by corneal conjunctivalization, persistent epithelial defects, and fibrovascular pannus.
• LSCD can manifest unilaterally or bilaterally, partially or totally, significantly impacting vision.
• Current treatments range from surgical debridement to limbal tissue transplantation.

Purpose of the Study:

• To review the management strategies for limbal stem cell deficiency (LSCD).
• To evaluate the efficacy of different limbal transplantation techniques.
• To highlight optimal surgical and postoperative care protocols.

Main Methods:

• Review of surgical options including sequential sector conjunctival epitheliectomy (SSCE) for partial LSCD.
• Analysis of limbal tissue transplantation from autologous, living related, and cadaver donors for total LSCD.
• Discussion of recipient site preparation, donor graft handling, and postoperative management.

Main Results:

• Autologous limbal grafts provide the best visual outcomes.
• Living related donor grafts are the second-best option, offering advantages like freshness and HLA matching.
• Cadaver grafts have a lower success rate, with most failing within 5 years. Long-term immunosuppression is required for allografts.

Conclusions:

• Limbal transplantation, despite complexities, significantly improves vision-related quality of life.
• Autografts and living related donor grafts are preferred for LSCD treatment.
• Meticulous preoperative, surgical, and postoperative care is crucial for successful outcomes.