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Autologous limbal stem cell transplantation: a systematic review of clinical outcomes with different surgical techniques
  1. Swapna S Shanbhag1,
  2. Neda Nikpoor2,
  3. Pragnya Rao Donthineni3,
  4. Vivek Singh4,
  5. James Chodosh5,
  6. Sayan Basu4
  1. 1 Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
  2. 2 Byers Eye Institute, Stanford University, Stanford, California, USA
  3. 3 Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, India
  4. 4 Center for Ocular Regeneration (CORE), LV Prasad Eye Institute, Hyderabad, India
  5. 5 Cornea and Refractive Surgery Service, MEEI, Boston, Massachusetts, USA
  1. Correspondence to Dr Sayan Basu, Center for Ocular Regeneration (CORE), LV Prasad Eye Institute, Hyderabad, Telangana 500034, India; sayanbasu{at}lvpei.org

Abstract

Purpose To conduct a systematic review on outcomes of three different techniques of autologous limbal stem cell transplantation (LSCT): conjunctival-limbal autografting (CLAu), cultivated limbal epithelial transplantation (CLET) and simple limbal epithelial transplantation (SLET), in unilateral limbal stem cell deficiency (LSCD).

Methods Literature searches were conducted in MEDLINE (Ovid), Embase, Web of Science and Cochrane Central Register. Standard systematic review methodology was followed using Meta-analysis of Observational Studies in Epidemiology guidelines. Studies with a sample size of more than 10 eyes were included. The primary outcome measure of efficacy was restoration of a completely epithelised, stable and avascular corneal surface (anatomical success). The secondary outcome measure of efficacy was improvement in best-corrected visual acuity of two-lines or greater (functional success).

Results The review identified 22 non-comparative case series, which included 1023 eyes. Ocular burns were the major (88%) indication for surgery. Overall, at a median postoperative follow-up of 1.75 years, autologous LSCT for unilateral LSCD showed anatomical and functional success rates of 69% and 60%, respectively, without any serious adverse events in the donor eye. The follow-up duration and indications for surgery were comparable across all groups (p>0.05). The anatomical and functional success rates of SLET (78%; 68.6%) and CLAu (81%; 74.4%) were comparable, and significantly better than those of CLET (61.4%; 53%; p=0.0048).

Conclusion Autologous LSCT is a safe and effective treatment for unilateral LSCD. In the absence of randomised controlled trials, existing evidence clearly suggests that clinical outcomes are better with SLET and CLAu as compared with CLET.

  • limbal stem cell transplantation
  • conjunctival limbal autograft
  • cultivated limbal epithelial transplantation
  • simple limbal epithelial transplantation
  • unilateral limbal stem cell deficiency
  • ocular chemical burns
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Footnotes

  • Contributors The corresponding author states that authorship credit of this manuscript was based on (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be published. All listed authors met conditions 1–3. All persons designated as authors qualify for authorship, and all those who qualify are listed. Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content.

  • Funding Hyderabad Eye Research Foundation, Hyderabad, India.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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