Systemic immunosuppression in limbal stem cell transplantation: best practices and future challenges

Area of Science:

• Ophthalmology
• Transplantation Immunology

Background:

• Ocular surface stem cell transplantation is crucial for treating limbal stem cell deficiency (LSCD).
• Systemic immunosuppression is often required as adjunctive therapy to prevent graft rejection and ensure ocular surface stability.
• Current evidence on optimal immunosuppressive regimens for LSCD is limited.

Purpose of the Study:

• To evaluate systemic immunosuppression regimens used in ocular surface stem cell transplantation for LSCD.
• To assess the benefits and adverse effects of these immunosuppressive strategies.
• To identify gaps in the current literature regarding immunosuppression for LSCD.

Main Methods:

• Systematic literature review of MEDLINE and EMBASE databases (1980-2015).
• Inclusion of 16 reports detailing surgical interventions, immunosuppressive agents, duration, outcomes, and adverse effects.
• Data extraction focused on ocular surface stability, follow-up times, and patient demographics.

Main Results:

• Keratolimbal allograft was the most common intervention for severe LSCD.
• Immunosuppressive regimens evolved from cyclosporine to combinations of mycophenolate mofetil and tacrolimus, often with corticosteroids.
• Patients adhering to long-term immunosuppression achieved 70-80% stable ocular surface rates.
• Adverse effects included hypertension, diabetes, and biochemical abnormalities, managed pharmacologically or by drug discontinuation.

Conclusions:

• Systemic immunosuppression is associated with favorable ocular surface stability in LSCD patients undergoing transplantation.
• Current literature lacks evidence-based guidelines for specific LSCD categories or graft types.
• Further randomized controlled trials and prospective studies are needed to optimize immunosuppressive strategies and inform clinical practice.