Management Of Limbal Stem Cell Deficiency Research Articles

Current and Emerging Therapies for Limbal Stem Cell Deficiency.

The corneal epithelium serves to protect the underlying cornea from the external environment and is essential for corneal transparency and optimal visual function. Regeneration of this epithelium is dependent on a population of stem cells residing in the basal layer of the limbus, the junction between the cornea and the sclera. The limbus provides the limbal epithelial stem cells (LESCs) with an optimal microenvironment, the limbal niche, which strictly regulates their proliferation and differentiation. Disturbances to the LESCs and/or their niche can lead to the pathologic condition known as limbal stem cell deficiency (LSCD) whereby the corneal epithelium is not generated effectively. This has deleterious effects on the corneal and visual function, due to impaired healing and secondary corneal opacification. In this concise review, we summarize the characteristics of LESCs and their niche, and present the current and future perspectives in the management of LSCD with an emphasis on restoring the function of the limbal niche.

Management of Limbal Stem Cell Deficiency: A Historical Perspective, Past, Present, and Future.

To review the management of limbal stem cell deficiency (LSCD) from a historical perspective, report the current treatment guidelines, and propose potential future treatments. A literature review was conducted to identify key publications regarding the management of LSCD since treatments were first reported. The advances in surgical treatments, as well as postoperative management, are described from a historical perspective. In addition, current treatment guidelines, as well as future management strategies, are discussed. The management of LSCD has changed dramatically during the last several decades. Before the understanding of the anatomy and physiology of the limbus, all patients with severe LSCD had a dismal prognosis. It was not until the understanding of the location and function of the limbal stem cells that successful management protocols could be formulated. This research gave rise to medical and surgical treatment that protected or replaced diseased or absent limbal stem cells. Understanding the role of the conjunctiva in severe ocular surface disease was also critical in the management of LSCD. Continued improvement in tissue harvesting and surgical techniques have led to improved outcomes in LSCD patients. Significant progress has been made during the last several decades to manage patients with LSCD. A substantial percent of patients can achieve improved visual acuity with current techniques. Continued research with new cell culture and tissue engineering techniques may be the next breakthrough to improve the outcomes for these most challenging patients.

Stem Cell-Based Treatment Modalities for Limbal Stem Cell Deficiency

Limbal stem cell deficiency (LSCD) is a complex ocular condition with difficulty in corneal epithelialization, persistent ep ithelial defects, corneal neovascularization, and corneal conjunctivalization. The reason underlying this condition could be either primary or secondary. Chemical and thermal burns, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trauma, aniridia, ectodermal dysplasia, and iatrogenic mechanism are in the etiologic scope of the disease. Management of LSCD remains a controversial issue of ophthalmology. There are several treatment alternatives regarding the mechanism of the disease. These options include surface reconstruction with amniotic membrane, autologous and allogeneic limbal stem cell (SC) transplantation, and keratoplasty. There has not been a consensus on the choice of the treatment procedure, although more recently, cultivated SC transplantation has been shown to be a promising treatment modality in the management of LSCD. This review aims to give the readers up-to-date information on LSCD.

Presentation, diagnosis and management of limbal stem cell deficiency

The human corneal surface epithelium is continuously repopulated by the limbal stem cells (LSCs). Limbal Stem Cell Deficiency (LSCD) can lead to corneal opacity and vascularization, with consequent visual impairment or blindness. Many acquired and congenital diseases can lead to LCSD by direct injury to the LSCs, destruction of LSC niche, or both. Based on the severity of the disease, LSCD can present with various symptoms and signs. Although LSCD can be detected clinically, laboratory tests are necessary to confirm the diagnosis and monitor the disease progression. This article concisely reviews the clinical presentation, techniques for diagnosis and management of LSCD.