Limbal stem cell deficiency: Current management

Abstract

Limbal stem cells (SCs) represent a key component of the corneal-conjunctival barrier and play a vital role in the regeneration and replacement of the corneal epithelium. These SCs are located in the basal region of the limbus, in the palisades of Vogt.Limbal SCs may be lost in a wide variety of conditions, the most common being chemical injury, thermal burns, Stevens-Johnson syndrome (SJS), and vernal keratoconjunctivitis. Limbal SC deficiency (LSCD) may result in a painful and blinding ocular surface disorder leading to epithelial defects and conjunctivilization of the cornea. The management of LSCD depends primarily on the laterality, extent of involvement of the eye, and the condition of the other eye. Amniotic membrane transplantation is an established technique used in acute stage to minimize the primary insult and prevent the development of LSCD. In cases of established LSCD, transplanted tissue may be derived from autologous or allogenic sources. Long-term results of cultured limbal epithelial stem cell transplant have demonstrated greater therapeutic success when compared to previous forms of treatment. Moreover, with the help of advances in microsurgical techniques and immunosuppressant drugs, clinical assessment of the outcome of ocular surface rehabilitative procedures grows increasingly optimistic. This article describes the role of SCs in corneal epithelial regeneration, as well as the etiology and clinical features of LSCD.