Limbal stem cell transplantation: current perspectives

Marwan Raymond Atallah, Sotiria Palioura, Victor L Perez, Guillermo Amescua Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Regeneration of the corneal surface after an epithelial insult involves division, m...

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Autores principales:	Atallah MR, Palioura S, Perez VL, Amescua G
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	limbal stem cell deficiency simple limbal epithelial transplantation (SLET) cultivated limbal epithelial transplantation (CLET) keratolimbal allograft (KLAL) Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/056d1c40c47b4576b89c6bcbd77f36ba
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spelling	oai:doaj.org-article:056d1c40c47b4576b89c6bcbd77f36ba2021-12-02T00:16:27ZLimbal stem cell transplantation: current perspectives1177-5483https://doaj.org/article/056d1c40c47b4576b89c6bcbd77f36ba2016-04-01T00:00:00Zhttps://www.dovepress.com/limbal-stem-cell-transplantation-current-perspectives-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Marwan Raymond Atallah, Sotiria Palioura, Victor L Perez, Guillermo Amescua Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Regeneration of the corneal surface after an epithelial insult involves division, migration, and maturation of a specialized group of stem cells located in the limbus. Several insults, both intrinsic and extrinsic, can precipitate destruction of the delicate microenvironment of these cells, resulting in limbal stem cell deficiency (LSCD). In such cases, reepithelialization fails and conjunctival epithelium extends across the limbus, leading to vascularization, persistent epithelial defects, and chronic inflammation. In partial LSCD, conjunctival epitheliectomy, coupled with amniotic membrane transplantation, could be sufficient to restore a healthy surface. In more severe cases and in total LSCD, stem cell transplantation is currently the best curative option. Before any attempts are considered to perform a limbal stem cell transplantation procedure, the ocular surface must be optimized by controlling causative factors and comorbid conditions. These factors include adequate eyelid function or exposure, control of the ocular surface inflammatory status, and a well-lubricated ocular surface. In cases of unilateral LSCD, stem cells can be obtained from the contralateral eye. Newer techniques aim at expanding cells in vitro or in vivo in order to decrease the need for large limbal resection that may jeopardize the “healthy” eye. Patients with bilateral disease can be treated using allogeneic tissue in combination with systemic immunosuppressive therapy. Another emerging option for this subset of patients is the use of noncorneal cells such as mucosal grafts. Finally, the use of keratoprosthesis is reserved for patients who are not candidates for any of the aforementioned options, wherein the choice of the type of keratoprosthesis depends on the severity of the disease. In summary, limbal stem cell transplantation improves both vision and quality-of-life in patients with ocular surface disorders associated with LSCD, and overall, the use of autologous tissue offers the best results. Future studies aim at improving cellular expansion and finding different sources of stem cells. Keywords: limbal stem cell deficiency (LSCD), simple limbal epithelial transplantation (SLET), cultivated limbal epithelial transplantation (CLET), keratolimbal allograft (KLAL)Atallah MRPalioura SPerez VLAmescua GDove Medical Pressarticlelimbal stem cell deficiencysimple limbal epithelial transplantation (SLET)cultivated limbal epithelial transplantation (CLET)keratolimbal allograft (KLAL)OphthalmologyRE1-994ENClinical Ophthalmology, Vol 2016, Iss Issue 1, Pp 593-602 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	limbal stem cell deficiency simple limbal epithelial transplantation (SLET) cultivated limbal epithelial transplantation (CLET) keratolimbal allograft (KLAL) Ophthalmology RE1-994
spellingShingle	limbal stem cell deficiency simple limbal epithelial transplantation (SLET) cultivated limbal epithelial transplantation (CLET) keratolimbal allograft (KLAL) Ophthalmology RE1-994 Atallah MR Palioura S Perez VL Amescua G Limbal stem cell transplantation: current perspectives
description	Marwan Raymond Atallah, Sotiria Palioura, Victor L Perez, Guillermo Amescua Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Regeneration of the corneal surface after an epithelial insult involves division, migration, and maturation of a specialized group of stem cells located in the limbus. Several insults, both intrinsic and extrinsic, can precipitate destruction of the delicate microenvironment of these cells, resulting in limbal stem cell deficiency (LSCD). In such cases, reepithelialization fails and conjunctival epithelium extends across the limbus, leading to vascularization, persistent epithelial defects, and chronic inflammation. In partial LSCD, conjunctival epitheliectomy, coupled with amniotic membrane transplantation, could be sufficient to restore a healthy surface. In more severe cases and in total LSCD, stem cell transplantation is currently the best curative option. Before any attempts are considered to perform a limbal stem cell transplantation procedure, the ocular surface must be optimized by controlling causative factors and comorbid conditions. These factors include adequate eyelid function or exposure, control of the ocular surface inflammatory status, and a well-lubricated ocular surface. In cases of unilateral LSCD, stem cells can be obtained from the contralateral eye. Newer techniques aim at expanding cells in vitro or in vivo in order to decrease the need for large limbal resection that may jeopardize the “healthy” eye. Patients with bilateral disease can be treated using allogeneic tissue in combination with systemic immunosuppressive therapy. Another emerging option for this subset of patients is the use of noncorneal cells such as mucosal grafts. Finally, the use of keratoprosthesis is reserved for patients who are not candidates for any of the aforementioned options, wherein the choice of the type of keratoprosthesis depends on the severity of the disease. In summary, limbal stem cell transplantation improves both vision and quality-of-life in patients with ocular surface disorders associated with LSCD, and overall, the use of autologous tissue offers the best results. Future studies aim at improving cellular expansion and finding different sources of stem cells. Keywords: limbal stem cell deficiency (LSCD), simple limbal epithelial transplantation (SLET), cultivated limbal epithelial transplantation (CLET), keratolimbal allograft (KLAL)
format	article
author	Atallah MR Palioura S Perez VL Amescua G
author_facet	Atallah MR Palioura S Perez VL Amescua G
author_sort	Atallah MR
title	Limbal stem cell transplantation: current perspectives
title_short	Limbal stem cell transplantation: current perspectives
title_full	Limbal stem cell transplantation: current perspectives
title_fullStr	Limbal stem cell transplantation: current perspectives
title_full_unstemmed	Limbal stem cell transplantation: current perspectives
title_sort	limbal stem cell transplantation: current perspectives
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/056d1c40c47b4576b89c6bcbd77f36ba
work_keys_str_mv	AT atallahmr limbalstemcelltransplantationcurrentperspectives AT paliouras limbalstemcelltransplantationcurrentperspectives AT perezvl limbalstemcelltransplantationcurrentperspectives AT amescuag limbalstemcelltransplantationcurrentperspectives
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Limbal stem cell transplantation: current perspectives

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