Keratolimbal allograft for limbal stem cell deficiency after severe corneal chemical injury: a systematic review

Shanbhag, Swapna S; Saeed, Hajirah N.; Paschalis, Eleftherios I.; Chodosh, James

doi:10.1136/bjophthalmol-2017-311249

Cited by 27 publications

(27 citation statements)

References 41 publications

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“…A recent systematic review on clinical outcomes of keratolimbal allograft in LSCD after severe corneal chemical injury evaluated six nonrandomized, controlled studies and reported a best corrected visual acuity ≥ 20/200 in 69% (20/29) of the eyes at the last follow-up examination (mean follow-up range 6.2–114 months). The authors concluded that the quality of the evidence to support the use of keratolimbal allograft in LSCD is low and further, standardized studies with long-term follow-up are needed [ 89 – 91 ]. In addition, different studies used different immunosuppression regimens after keratolimbal allograft; in fact, even if most studies used systemic cyclosporine, there is not a standardized immunosuppressive regimen for keratolimbal allograft [ 91 ].…”

Section: Clinical Resultsmentioning

confidence: 99%

“…The authors concluded that the quality of the evidence to support the use of keratolimbal allograft in LSCD is low and further, standardized studies with long-term follow-up are needed [ 89 – 91 ]. In addition, different studies used different immunosuppression regimens after keratolimbal allograft; in fact, even if most studies used systemic cyclosporine, there is not a standardized immunosuppressive regimen for keratolimbal allograft [ 91 ]. In most cases, the interpretation of the results has been hampered either by the lack of a proper genetic evaluation of the presumptive long-term engraftment of allogeneic limbal grafts or by the inadequate length of the follow-up.…”

Section: Clinical Resultsmentioning

confidence: 99%

“…The main problems are related to bilateral LSCD without any spared limbal area which does not allow obtaining autologous limbal stem cells to be transplanted. Use of alternative sources of stem cells, such as oral mucosa, bone marrow-derived mesenchymal stem cells, or iPS cells, is under evaluation as alternative to limbal allografts obtained from cadaver or living relatives [ 91 , 109 , 110 ]. As alternative, implantation of an artificial cornea (keratoprosthesis) has been proposed for treatment of bilateral LSCD [ 111 ].…”

Section: Clinical Resultsmentioning

confidence: 99%

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Limbal Stem Cell Transplantation: Clinical Results, Limits, and Perspectives

Sacchetti

Rama

Bruscolini

2018

Stem Cells International

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Limbal stem cell deficiency (LSCD) is a clinical condition characterized by damage of cornea limbal stem cells, which results in an impairment of corneal epithelium turnover and in an invasion of the cornea by the conjunctival epithelium. In these patients, the conjunctivalization of the cornea is associated with visual impairment and cornea transplantation has poor prognosis for recurrence of the conjunctivalization. Current treatments of LSCD are aimed at replacing the damaged corneal stem cells in order to restore a healthy corneal epithelium. The autotransplantation of limbal tissue from the healthy, fellow eye is effective in unilateral LSCD but leads to depauperation of the stem cell reservoir. In the last decades, novel techniques such as cultivated limbal epithelial transplantation (CLET) have been proposed in order to reduce the damage of the healthy fellow eye. Clinical and experimental evidence showed that CLET is effective in inducing long-term regeneration of a healthy corneal epithelium in patients with LSCD with a success rate of 70%–80%. Current limitations for the treatment of LSCD are represented by the lack of a marker able to unequivocally identify limbal stem cells and the treatment of total, bilateral LSCD which requires other sources of stem cells for ocular surface reconstruction.

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Section: Clinical Resultsmentioning

confidence: 99%

Section: Clinical Resultsmentioning

confidence: 99%

Section: Clinical Resultsmentioning

confidence: 99%

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Limbal Stem Cell Transplantation: Clinical Results, Limits, and Perspectives

Sacchetti

Rama

Bruscolini

2018

Stem Cells International

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“…In patients with bilateral LSCD, limbal stem cells may be harvested from immediate family members as a livingrelated conjunctival-limbal allograft (lr-CLAL), cadaveric eyes as a keratolimbal allograft (KLAL) or allogenic cultivated limbal epithelial transplantation (allo-CLET) [93,94]. These allogeneic transplants obviously require systemic immune suppression.…”

Section: Management Of Chronic Complicationsmentioning

confidence: 99%

“…A recent systemic review looked at studies in which KLAL was done for chemical injury induced total LSCD. Eightynine percent underwent simultaneous or subsequent penetrating keratoplasty [94]. Median follow-up for 29 eyes was 42 months (range: 6.2-114 months), and 69% had BCVA ≥20/200 at last follow-up.…”

Section: Management Of Chronic Complicationsmentioning

confidence: 99%

An update on chemical eye burns

Bizrah

Yusuf²,

Ahmad

2019

Eye

106

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Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as key challenges. Education and prevention are therefore important public health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherence rates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.

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Outcomes of Limbal Stem Cell Transplant

Chauhan

Yung

et al. 2020

JAMA Ophthalmol

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IMPORTANCE Limbal stem cell transplant (LSCT) can be categorized as direct autologous limbal transplant (AULT), direct allogenic limbal transplant (ALLT), cultivated autologous limbal stem cells transplant (cAULT), and cultivated allogenic limbal stem cells transplant (cALLT). To our knowledge, there is no study directly comparing the outcomes and complications of these procedures.OBJECTIVE To evaluate the outcomes of different LSCT procedures.DATA SOURCE We searched PubMed, EMBASE, Web of Science, and Cochrane without language filter for peer-reviewed articles about LSCT. The latest search was performed on June 30, 2019.STUDY SELECTION Clinical studies with the outcome of at least 20 eyes after LSCT were included. Animal studies and studies of other surgical interventions were excluded. DATA EXTRACTION AND SYNTHESISTwo reviewers independently abstracted the data from each study. Heterogeneity was evaluated with the I 2 statistic, and a meta-analysis was performed using the random-effects model. MAIN OUTCOMES AND MEASURESOutcome measures included the improvement of ocular surface, visual acuity (VA), and adverse events of recipient eyes and donor eyes.RESULTS Forty studies (2202 eyes) with a mean (SD) follow-up of 31.3 (20.9) months met the inclusion criteria. The mean (SD) age of study participants was 38.4 (13.1) years, and men accounted for 74%. The number of eyes that underwent AULT, ALLT, cAULT, and cALLT were 505, 742, 771, and 184, respectively. Improvement of the ocular surface was achieved in 74.5% of all eyes, 85.7% of eyes after AULT (95% CI, 79.5%-90.3%), 84.7% after cAULT (95% CI, 77.2%-90.0%), 57.8% after ALLT (95% CI, 49.0%-66.1%), and 63.2% after cALLT (95% CI, 49.3%-75.2%). Autologous limbal transplantation resulted in a greater VA improvement rate (76%) than did the other 3 procedures (cAULT: 56.4%; ALLT: 52.3%; cALLT: 43.3%; all P < .001). The most common adverse events in all recipient eyes were recurrent/persistent epithelial erosion (10.5%; 95% CI, 7.2%-23.3%) and elevated intraocular pressure (intraocular pressure, 1.7%; 95% CI, 0.5%-7.8%). Patients who underwent ALLT had the highest rate of recurrent epithelial erosion (27.8%; 95% CI, 17.1%-41.9%) and intraocular pressure elevation (6.3%; 95% CI, 1.8%-19.4%). CONCLUSIONS AND RELEVANCEThese findings suggest LSCT can improve or stabilize the corneal surface with a low rate of severe ocular complications and that autologous LSCT may have a higher success rate and fewer complications than allogenic LSCT.

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Keratolimbal allograft for limbal stem cell deficiency after severe corneal chemical injury: a systematic review

Abstract: CRD42017054733.

Cited by 27 publications

References 41 publications

Limbal Stem Cell Transplantation: Clinical Results, Limits, and Perspectives

Limbal Stem Cell Transplantation: Clinical Results, Limits, and Perspectives

An update on chemical eye burns

Outcomes of Limbal Stem Cell Transplant

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