Limbal Stem Cell Deficiency—Demography and Underlying Causes

Vazirani, Jayesh; Nair, Dhanyasree; Shanbhag, Swapna S; Wurity, Siva; Ranjan, Abhishek; Sangwan, Veena

doi:10.1016/j.ajo.2018.01.020

Cited by 86 publications

(66 citation statements)

References 18 publications

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“…The reported incidence of severe chemical injury in the UK is 0.02 per 100,000 per annum, although this seems to be an underestimation when compared with our own data [14]. Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is one of the leading causes of bilateral LSCD [12] and has an incidence of approximately 0.6 per 100,000 per annum [15]. Estimating the incidence of LSCD from its common causes gives around 240 new cases per annum in the UK [16].…”

Section: Introductioncontrasting

confidence: 59%

“…Chemical injury is by far the most common cause of unilateral LSCD, responsible for around 66-75% of cases requiring LSC transplantation according to previous analysis of globally reported cases [10,11]. In a developing world setting, chemical injury was found to be responsible for 84% of all cases of unilateral LSCD [12]. A case series of all chemical eye injuries reporting to our casualty department demonstrated an incidence of 5.6 cases per 100,000 population.…”

Section: Introductionmentioning

confidence: 73%

“…Acquired non-immune LSCD is caused by direct injurious effects on the LSCs and/or their limbal niche. These causes include chemical [12,20], thermal and radiation injury, infection [19], contact lens wear [17,21,22], ocular neoplasm [23], and direct toxicity of topical anti-cancer drugs [23]. Acquired immune-related causes include SJS/TEN, mucous membrane pemphigoid, allergic eye disease, scleritis [24], and graft-versus-host disease [25].…”

Section: Introductionmentioning

confidence: 99%

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Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

2020

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Destruction of the limbus and depletion of limbal stem cells (LSCs), the adult progenitors of the corneal epithelium, leads to limbal stem cell deficiency (LSCD). LSCD is a rare, progressive ocular surface disorder which results in conjunctivalisation and neovascularisation of the corneal surface. Many strategies have been used in the treatment of LSCD, the common goal of which is to regenerate a self-renewing, transparent, and uniform epithelium on the corneal surface. The development of these techniques has frequently resulted from collaboration between stem cell translational scientists and ophthalmologists. Direct transplantation of autologous or allogeneic limbal tissue from a healthy donor eye is regarded by many as the technique of choice. Expansion of harvested LSCs in vitro allows smaller biopsies to be taken from the donor eye and is considered safer and more acceptable to patients. This technique may be utilised in unilateral cases (autologous) or bilateral cases (living related donor). Recently developed, simple limbal epithelial transplant (SLET) can be performed with equally small biopsies but does not require in vitro cell culture facilities. In the case of bilateral LSCD, where autologous limbal tissue is not available, autologous oral mucosa epithelium can be expanded in vitro and transplanted to the diseased eye. Data on long-term outcomes (over 5 years of follow-up) for many of these procedures is needed, and it remains unclear how they produce a self-renewing epithelium without recreating the vital stem cell niche. Bioengineering techniques offer the ability to recreate the physical characteristics of the stem cell niche, while induced pluripotent stem cells offer an unlimited supply of autologous LSCs. In vivo confocal microscopy and anterior segment OCT will complement impression cytology in the diagnosis, staging, and follow-up of LSCD. In this review we analyse recent advances in the pathology, diagnosis, and treatment of LSCD.

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Section: Introductioncontrasting

confidence: 59%

Section: Introductionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

2020

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“…A recent paper by Vazirani, et al, reviewed the demographic features and causes of with LSCD in 1331 patients. 18 They reported that unilateral was more common than bilateral (59.4% versus 40.6%). Males comprised 65.7% and the median age was 24-years.…”

Section: Overviewmentioning

confidence: 98%

A Review of Limbal Stem Cell Deficiency

Conto

2019

JDED

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Limbal stem cell deficiency (LSCD) can be secondary to multiple etiologies including contact lens wear, chemical or thermal trauma, and systemic disease, any of which can result in the reduction of the number of stem cells or their decreased functionality. Primary LSCD is seen with a variety of congenital anterior segment disorders. Often LSCD can be stabilized and timely diagnosis is the key. The use of topical corticosteroids and artificial tear lubricants, along with treatment of any underlying conditions, and discontinuation of contact lenses are important initial treatment strategies. Advance treatments include amniotic membranes, limbal stem cell transplantation and keratoprostheses.

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“…Limbal Vernal Keratoconjunctivitis (VKC) is one of the known causes of Limbal Stem Cell Deficiency (LCSD)[ 1 ] and has recently gained importance because of the long-term implications of chronic limbal inflammation being documented. [ 2 ] We report 2 cases from the same family, presenting with features of either end of the spectrum.…”

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confidence: 99%