Treating limbal stem cell deficiency: current and emerging therapies

Abstract

Introduction: Based on scientific research, most experts agree that the limbal stem cells reside in a special microenvironment at the limbus. Insult to this microenvironment leads to limbal stem cell deficiency (LSCD). LSCD invariably manifests as corneal pannus formation, which over a period of time allows the ocular surface reconstructive procedures to be carried out.Areas covered: This review article describes both the current and emerging treatment strategies. The current treatment strategies include conjunctival limbal autograft, cultivated limbal epithelial transplantation (CLET) and simple limbal epithelial transplantation for unilateral cases. Keratolimbal allograft, allogenic CLET, keratoprosthesis and cultivated oral mucosal transplantation are meant for bilateral cases. The emerging treatment modalities include tissue-engineering approaches, stem cell-based regenerative therapies and ocular surface regeneration using embryonic stem cells, induced pluripotent and mesenchymal stem cells.Expert opinion: Each of the above-mentioned techniques continues to be practiced for the treatment of LSCD worldwide. None of the single techniques is perfect and that is why there are so many in practice. Each technique has its unique advantages and limitations. At the same time, there are several new and emerging options to tackle complex cases of LSCD. In this review, we discuss applications of new and emerging techniques as well as established and conventional procedures.