Current and future options for ocular surface reconstruction, including ocular surface stem cell transplantation (limbal stem cell transplantation)

Abstract

ABSTRACT Introduction Conjunctival and limbal stem cell deficiency (LSCD) cause decompensation of the ocular surface. Besides causing poor vision and chronic pain, these conditions remain a challenge to rehabilitate. Areas covered The goal of this review was to describe surgical techniques to aid in reconstructing the ocular surface. Acute treatments (i.e. amniotic membrane transplantation, tenonplasty) are intended to minimize inflammatory damage and prevent sequelae. Partial LSCD may be initially treated with a sectorial conjunctival epitheliectomy or ipsilateral limbal translocation. Total/near-total LSCD often requires an ocular surface stem cell transplantation (OSST) to restore the ocular surface. A mucous membrane graft or other tissue graft can help reconstruct the fornix and address dense symblephara/ankyloblephara prior to OSST. Expert opinion There has been a burgeoning of different variations on the main OSST types with a trend toward combined procedures, harvesting smaller amounts of either limbal or mucosal tissue, and utilizing autologous non-limbal stem cell (i.e. oral mucosal conjunctival) tissue on the corneal surface. We are cautiously optimistic as we await intermediate-term and long-term results to be published. While we note resistance among corneal specialists to perform these treatments, we hope that increased exposure in training and knowledge of these procedures’ success will increase adoption.