scholarly journals Limbal Stem Cell Deficiency: Current Treatment Options and Emerging Therapies

2016 ◽  
Vol 2016 ◽  
pp. 1-22 ◽  
Author(s):  
Michel Haagdorens ◽  
Sara Ilse Van Acker ◽  
Veerle Van Gerwen ◽  
Sorcha Ní Dhubhghaill ◽  
Carina Koppen ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Stem Cell ◽  
Ocular Surface ◽  
Treatment Options ◽  
Current Treatment ◽  
Limbal Stem Cell Deficiency ◽  
Success Rates ◽  
Epithelial Stem Cells ◽  
Advantages And Disadvantages ◽  
Limbal Stem Cell

Severe ocular surface disease can result in limbal stem cell deficiency (LSCD), a condition leading to decreased visual acuity, photophobia, and ocular pain. To restore the ocular surface in advanced stem cell deficient corneas, an autologous or allogenic limbal stem cell transplantation is performed. In recent years, the risk of secondary LSCD due to removal of large limbal grafts has been significantly reduced by the optimization of cultivated limbal epithelial transplantation (CLET). Despite the great successes of CLET, there still is room for improvement as overall success rate is 70% and visual acuity often remains suboptimal after successful transplantation. Simple limbal epithelial transplantation reports higher success rates but has not been performed in as many patients yet. This review focuses on limbal epithelial stem cells and the pathophysiology of LSCD. State-of-the-art therapeutic management of LSCD is described, and new and evolving techniques in ocular surface regeneration are being discussed, in particular, advantages and disadvantages of alternative cell scaffolds and cell sources for cell based ocular surface reconstruction.

scholarly journals Emerging Therapeutic Strategies for Limbal Stem Cell Deficiency

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Ying Dong ◽  
Han Peng ◽  
Robert M. Lavker
Keyword(s):  
Stem Cell ◽  
Corneal Epithelium ◽  
Ocular Surface ◽  
Limbal Stem Cell Deficiency ◽  
Current Status ◽  
Epithelial Stem Cells ◽  
Therapeutic Approaches ◽  
Advantages And Disadvantages ◽  
Limbal Stem Cell ◽  
Novel Therapeutic

Identification and characterization of the limbal epithelial stem cells (LESCs) has proven to be a major accomplishment in anterior ocular surface biology. These cells have been shown to be a subpopulation of limbal epithelial basal cells, which serve as the progenitor population of the corneal epithelium. LESCs have been demonstrated to play an important role in maintaining corneal epithelium homeostasis. Many ocular surface diseases, including intrinsic (e.g., Sjogren’s syndrome) or extrinsic (e.g., alkali or thermal burns) insults, which impair LESCs, can lead to limbal stem cell deficiency (LSCD). LSCD is characterized by an overgrowth of conjunctival-derived epithelial cells, corneal neovascularization, and chronic inflammation, eventually leading to blindness. Treatment of LSCD has been challenging, especially in bilateral total LSCD. Recently, advances in LESC research have led to novel therapeutic approaches for treating LSCD, such as transplantation of the cultured limbal epithelium. These novel therapeutic approaches have demonstrated efficacy for ocular surface reconstruction and restoration of vision in patients with LSCD. However, they all have their own limitations. Here, we describe the current status of LSCD treatment and discuss the advantages and disadvantages of the available therapeutic modalities.

scholarly journals Case series of cultivated oral mucosa epithelium transplantation for limbal stem cell failure

2018 ◽  
Vol 16 (2) ◽  
pp. 110-118
Author(s):  
Kah Lay Oh ◽  
Aida Zahidin ◽  
Umi Kalthum Md Noh ◽  
Safinaz Mohd Khialdin ◽  
Ghee Chien Ooi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Stem Cell ◽  
Oral Mucosa ◽  
Ocular Surface ◽  
Case Series ◽  
Limbal Stem Cell Deficiency ◽  
Corneal Transplant ◽  
Ocular Rosacea ◽  
Limbal Stem Cell ◽  
Mucosa Epithelium

Purpose: To report a case series of seven eyes (six patients) with severe limbal stem cell failure who underwent cultivated oral mucosa epithelium transplantation (COMET) in preparation for corneal transplant surgery and assess the change in visual acuity postoperatively. Design: Case series. Methods: A retrospective analysis of an interventional case series of six patients with severe limbal stem cell deficiency who underwent COMET between 2012 and 2015 was performed. Six eyes had COMET followed by corneal transplant, and one eye had corneal transplant preceding COMET. The change in the visual acuity after operation was evaluated. Results: A total of six patients with seven eyes were studied. All of them had severe ocular surface disease with limbal stem cell deficiency (LSCD) secondary to chemical injury (five eyes), SJS (one eye), and severe ocular rosacea (one eye). Four eyes had improvements in visual acuity, two of which achieved best corrected visual acuity (BCVA) of 6/12. Conclusion: The use of COMET helps to optimize the ocular surface in severe LSCD for further corneal transplant surgeries. It has helped to improve the graft uptake and subsequent visual improvement, especially in chronic chemical burn cases.  

scholarly journals Current approaches to the problem of carrier selection for limbal stem cells cultivation in the treatment of limbal stem cell deficiency

2018 ◽  
Vol 11 (2) ◽  
pp. 48-56 ◽  
Author(s):  
Alexey N. Kulikov ◽  
Sergey V. Churashov ◽  
Valeriy F. Chernysh ◽  
Miralda I. Blinova ◽  
Olga I. Alexandrova ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Ocular Surface ◽  
Contact Lenses ◽  
Ex Vivo ◽  
Limbal Stem Cell Deficiency ◽  
Epithelial Stem Cells ◽  
Limbal Stem Cells ◽  
Carrier Selection ◽  
Limbal Stem Cell

Diseases and damages of the ocular surface are one of the common causes of decreased vision and blindness. Dysfunction or death of limbal epithelial stem cells (LESC) plays an important role in the development of pathological processes in these conditions, which leads to the development of the limbal stem cell deficiency (LSCD). Currently, one of the methods to treat LSCD is a transplantation of cultured ex vivo LESC. The most common carriers for the cultivation of LESC in the world is the amniotic membrane (AM). However, the presence of certain disadvantages in using AM for the cultivation of LESC compels to search new types of carriers made from biological or synthetic materials. In this review, we have analyzed various types of carriers: collagen, fibrin, chitosan with gelatin, silk fibroin, keratin, contact lenses, polylactide-co-glycolide, polycaprolactone, and the possibility of their application as carriers for the LESC cultivation followed by transplantation on the ocular surface is considered.

scholarly journals Midterm outcomes of penetrating keratoplasty following allogeneic cultivated limbal epithelial transplantation in patients with bilateral limbal stem cell deficiency

2021 ◽  
Vol 14 (11) ◽  
pp. 1690-1699
Author(s):  
Jun-Fa Xue ◽  
◽  
Ya-Ni Wang ◽  
Chen Chen ◽  
Ru-Fei Yang ◽  
...  
Keyword(s):  
Stem Cell ◽  
Graft Survival ◽  
Graft Rejection ◽  
Ocular Surface ◽  
Penetrating Keratoplasty ◽  
Limbal Stem Cell Deficiency ◽  
Time Interval ◽  
Case Series Study ◽  
Limbal Stem Cell ◽  
Cultivated Limbal Epithelial Transplantation

AIM: To evaluate the midterm outcomes of penetrating keratoplasty (PK) following allogeneic cultivated limbal epithelial transplantation (CLET) for bilateral total limbal stem cell deficiency (LSCD). METHODS: Ten patients (10 eyes) with bilateral LSCD were enrolled in this prospective noncomparative case series study. Each participant underwent PK approximately 6mo after a CLET. Topical tacrolimus, topical and systemic steroids, and oral ciclosporin were administered postoperatively. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular surface grading scores (OSS), corneal graft epithelial rehabilitation, persistent epithelial defect (PED), immunological rejection, and graft survival rate were assessed. RESULTS: The time interval between PK and allogeneic CLET was 6.90±1.29 (6-10)mo. BCVA improved from 2.46±0.32 logMAR preoperatively to 0.77±0.55 logMAR post-PK (P<0.001). Kaplan-Meier analysis of mean graft survival revealed graft survival rates of 100% at 12 and 24mo and 80.0% at 36mo. PEDs appeared in 5 eyes at different periods post-PK, and graft rejection occurred in 4 eyes. The total OSS decreased from 12.4±4.4 before allogeneic CLET to 1.4±1.51 after PK. CONCLUSION: A sequential therapy design of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite the relatively high graft rejection rate.

scholarly journals Surgical Success Evaluation in Limbal Stem Cell Deficiency Due to Chemical Injury – How to Be Accurate?

2021 ◽  
Author(s):  
Ilayda Korkmaz ◽  
Melis Palamar ◽  
Sait Egrilmez ◽  
Mehmet Gurdal ◽  
Ayse Yagci ◽  
...  
Keyword(s):  
Stem Cell ◽  
Success Rate ◽  
Cell Transplantation ◽  
Limbal Stem Cell Deficiency ◽  
Grading System ◽  
Success Rates ◽  
Surgical Success ◽  
Chemical Injury ◽  
The Mean ◽  
Limbal Stem Cell

Abstract Purpose: To evaluate limbal stem cell transplantation (LSCT) success in limbal stem cell deficiency (LSCD) due to chemical injury in a tertiary eye care center in Turkey by using ‘Limbal Stem Cell Working Group’ LSCD grading system.Methods: Medical records of 80 eyes of 80 patients who underwent LSCT for LSCD secondary to chemical injury were included. The patients were divided into 3 groups according to performed surgery as limbal autograft, limbal allograft, cultivated limbal epithelial cell transplantation (CLET). Surgical success was defined as improvement in the post-operative 1st year LSCD stage.Results: The mean age of the patients was 37.9±15.7(4-71) with a Male/Female ratio of 2.4. Forty-five(56.3%) patients were injured with alkaline and 16(20%) were injured with acid substance. The mean follow-up time was 60.3±30.6(6-118.6) months. Limbal autograft, allograft and CLET were performed in 58(72.5%), 12(15%) and 10(12.5%) eyes, respectively. The interval between injury and surgery in limbal autograft, limbal allograft and CLET were 43.3±94.1(0.5-592); 14.5±10.6(2.4-32.5) and 122.8±158.9(21.1-504) months, respectively (p=0.02). The overall surgical success rate was 65%. Surgical success rates in each groups were 65.5%, 41.7% and 90%, respectively (p=0.03).Conclusion: It is vital to accurately determine the stage of the LSCD in order to evaluate the surgical success rates. Surgery type and a longer time interval between the chemical injury and surgery seems to be the most important factors associated with a higher surgical success rate. Despite the limited subject number for subgroups, the results were remarkable to emphasize the significance of the novel LSCD grading system.

scholarly journals Clinical outcomes of autologous cultured oral mucosal epithelium transplantation for treatment of limbal stem cell deficiency

2020 ◽  
pp. 77-85
Author(s):  
B.E. Malyugin ◽  
◽  
S.A. Borzenok ◽  
M.Y. Gerasimov ◽  
◽  
...  
Keyword(s):  
Clinical Trials ◽  
Visual Acuity ◽  
Stem Cell ◽  
Underlying Disease ◽  
Corneal Neovascularization ◽  
Limbal Stem Cell Deficiency ◽  
Complication Rates ◽  
Mucosal Epithelium ◽  
Ocular Surface Reconstruction ◽  
Limbal Stem Cell

The review presents an analysis of clinical trials results for autologous cultured oral mucosal epithelium transplantation (COMET) in patients with bilateral corneal limbal stem cell deficiency (LSCD) over the past 15 years. Detailed characteristics and evaluation are given for anatomical outcomes, visual acuity changes, and complication rates. The results obtained during the analysis confirm the consistency of the concept of corneal re-epithelization by means of COMET. COMET promoted persistent corneal re-epithelization in 81.5% of cases, and visual acuity improvement in 78.8% of patients with LSCD. COMET does not require systemic immunosuppression, and it is accompanied by much smaller numbers and significantly lower grades of complications compared with keratoprosthesis. About 15% of patients experienced developing superficial peripheral corneal neovascularization regressed spontaneously by 12 months of observation. Based on the COMET clinical trials results, the management of patients with bilateral LSCD is under optimization by reference to the pathogenesis of the underlying disease. Thus, autologous cultured oral mucosal epithelium transplantation seems promising for further studies and introduction into routine clinical practice. Key words: limbal stem cell deficiency, ocular surface reconstruction, corneal epithelium, oral mucosal epithelium, transplantation.

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