Systematic review and meta-analysis investigating autograft versus allograft cultivated limbal epithelial transplantation in limbal stem cell deficiency

Mishan, Mohammad Amir; Yaseri, Mehdi; Baradaran‐Rafii, Alireza

doi:10.1007/s10792-019-01092-x

Cited by 18 publications

(14 citation statements)

References 56 publications

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“…[7][8][9] Clinical and cytopathological criteria for the diagnosis of LSCD Patients presenting with chronic inflammation, conjunctivalization, corneal neovascularization, epithelial haze, or persistent or recurrent epithelial defects, and had clinical history of thermal and chemical burns, mustard gas keratopathy, ocular cicatricial abnormalities or aniridia, were clinically suspected to LSCD. 10 Observation of PAS-positive goblet cells among the epithelial sheets on the corneal side was diagnostic of LSCD (Figure 1(b)) and corneal conjunctivalization. 11,12 Clinical and cytopathological criteria for the diagnosis of OSSN OSSN was clinically suspected when there was a conjunctival/corneal epithelial overgrowth of telangiectatic feeder vessels with or without surface keratinization.…”

Section: Clinical and Cytopathological Criteria For The Diagnosis Of Derdmentioning

confidence: 98%

Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study

Moshtaghion

Abolhosseini

Kanavi

et al. 2020

European Journal of Ophthalmology

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Purpose: Investigating impression cytology (IC) results of various types of clinically suspected ocular surface lesions over a 14-year period in a referral center in Iran. Methods: IC findings obtained from patients with different types of ocular surface disorders between 2005 and 2018 were reviewed. Agreement between clinical suspicions and IC results was evaluated by calculating Cohen’s Kappa coefficient (CKC). Results: Clinical suspicions in 688 surveyed eyes were ocular surface squamous neoplasia (OSSN, 42.0%), limbal stem cell deficiency (LSCD, 36.3%), dry eye-related disorders (DERD, 11.5%), Acanthamoeba keratitis (AK, 7.2%), benign pigmented lesions (BPL, 1.9%), immune-related conjunctivitis (IRC, 0.7%), and malignant pigmented lesions (MPL, 0.4%). General agreement between clinical suspicions and IC results was 0.68 for all groups. This agreement was almost perfect in AK (CKC = 0.966) and BPLs (CKC = 0.843), and was substantial in MPLs (CKC = 0.749), OSSNs (CKC = 0.684), and LSCD (CKC = 0.612). CKC in IRC (0.567) and DERDs (0.443) was moderate. Histopathologic results were available in 22 eyes and were well-correlated with corresponding IC results (CKC = 0.86). Multiple post-treatment follow-up sessions of IC were performed in 51 eyes (11.4%) that had diagnosis of LSCD (31), OSSN (17), and MPL (3) at the first IC session. Conclusion: Our survey not only demonstrated an overall substantial agreement between IC results and primary clinical suspicions, but also showed an almost perfect correlation between IC results and existent histopathologic data. Therefore, IC as a non-invasive diagnostic modality can be of great importance in proper diagnosis of various ocular surface diseases especially when distinguishing malignant from benign lesions is required.

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Section: Clinical and Cytopathological Criteria For The Diagnosis Of Derdmentioning

confidence: 98%

Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study

Moshtaghion

Abolhosseini

Kanavi

et al. 2020

European Journal of Ophthalmology

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“…The great advancement of Pellegrini and Rama’s group [ 22 , 36 , 37 ] prompted many other groups to start developing similar protocols with some modifications in culture, evaluation procedures, and surgical techniques. There are consequently some published reports, especially in Asia and Europe [ 39 ], on autologous CLET with success rates varying from 60% to 100% [ 40 , 41 ].…”

Section: The Present: Available Stem Cell-based Therapiesmentioning

confidence: 99%

Goals and Challenges of Stem Cell-Based Therapy for Corneal Blindness Due to Limbal Deficiency

et al. 2021

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Corneal failure is a highly prevalent cause of blindness. One special cause of corneal failure occurs due to malfunction or destruction of the limbal stem cell niche, upon which the superficial cornea depends for homeostatic maintenance and wound healing. Failure of the limbal niche is referred to as limbal stem cell deficiency. As the corneal epithelial stem cell niche is easily accessible, limbal stem cell-based therapy and regenerative medicine applied to the ocular surface are among the most highly advanced forms of this novel approach to disease therapy. However, the challenges are still great, including the development of cell-based products and understanding how they work in the patient’s eye. Advances are being made at the molecular, cellular, and tissue levels to alter disease processes and to reduce or eliminate blindness. Efforts must be coordinated from the most basic research to the most clinically oriented projects so that cell-based therapies can become an integrated part of the therapeutic armamentarium to fight corneal blindness. We undoubtedly are progressing along the right path because cell-based therapy for eye diseases is one of the most successful examples of global regenerative medicine.

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“…As the grafts are expanded from a small biopsy, they presumably contain very low numbers of antigen-presenting Langerhans cells, melanocytes, and vascular endothelium found in the normal LSC niche [4]. Two systematic reviews investigating the outcomes of CLET found no significant difference in treatment success or visual improvement after autologous and allogeneic CLET [10,89], although a phase II clinical trial reported a high risk of graft rejection and subsequent failure after allogeneic CLET [90].…”

Section: Cultivated Limbal Epithelial Transplant (Clet)mentioning

confidence: 99%

“…CLET is a relatively new procedure, and therefore there is little data showing long-term ([ 5 years) graft survival let alone cure of LSCD, although outcomes in the short term (mean follow-up being less than 3 years for the vast majority of reported studies) have been very good, with around 67% success at final followup [10,89]. Behaegal et al found a drop-off in best-corrected visual acuity and success rate between short (2-year)-and long-term (7-year)follow-up in a cohort of mostly autologous grafts [88].…”

Section: Cultivated Limbal Epithelial Transplant (Clet)mentioning

confidence: 99%

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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Systematic review and meta-analysis investigating autograft versus allograft cultivated limbal epithelial transplantation in limbal stem cell deficiency

Cited by 18 publications

References 56 publications

Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study

Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study

Goals and Challenges of Stem Cell-Based Therapy for Corneal Blindness Due to Limbal Deficiency

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

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