[Current and future therapeutic options in limbal stem cell insufficiency]

Therapy for limbal stem cell insufficiency (LSCI) is one of the most challenging tasks in ocular surface surgery. Partial and unilateral LSCI can be treated by fractionated abrasion or autologous limbal stem cell transplantation from the fellow eye. In cases of advanced bilateral and partial LSCI, transplantation of ex vivo expanded sheets of limbal stem cells on amniotic membrane or fibrin may be performed. All patients with complete bilateral LSCI must rely on allogenic limbal stem cell transplantation comprising higher immunological risks. Progress using this technique has been achieved by the application of mitomycin C and amniotic membrane. Alternatively, transplantation of ex vivo expanded oral mucosal sheets may be used in bilateral LSCI, but only few long-term data are available on this technique as yet. While experimental attempts to use transdifferentiated bone marrow stem cells as a substitute for corneal epithelial cells have been without success, transdifferentiation of hair follicle stem cells to corneal epithelial cells may be more promising due to the identical lineage. But these experiments have not gone beyond the in vitro stage yet.