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  • Comparison of 3 approaches to autologous limbal stem cell transplantation

    Cornea/External Disease

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    Review of: Autologous limbal stem cell transplantation: a systematic review of clinical outcomes with different surgical techniques

    Shanbhag S, Nikpoor N, Donthineni P, et al. British Journal of Ophthalmology, January 2020

    This systematic review evaluated evidence relating to 3 different autologous limbal stem cell transplantation (LSCT) techniques.

    Study design

    The authors compared conjunctival-limbal autografting (CLAu), cultivated limbal epithelial transplantation (CLET) and simple limbal epithelial transplantation (SLET) for treatment of unilateral limbal stem cell deficiency (LSCD). The review included 22 noncomparative case series that comprised 1,023 eyes. The authors employed the standard systematic review method by following guidelines for Meta-analysis of Observation Studies in Epidemiology. The primary outcome measure of efficacy was anatomic success (restoration of a stable and avascular corneal surface) and the secondary outcome measure was functional success (>2 lines of BSCVA improvement).

    Outcomes

    At a median postop follow-up of 1.75 years, 69% of all eyes undergoing LSCT achieved anatomic success and 61% achieved functional success. There were no serious complications in the donor eyes. Statistically, SLET and CLAu had significantly better anatomical and functional outcomes compared with CLET. Although SLET and CLAu had almost identical anatomic success, CLAu showed a trend toward superior functional outcomes.

    Limitations

    The results of this systematic review should not be extrapolated to other indications because the major indication for surgery among the studies assessed was ocular, specifically chemical, burns.

    Clinical significance

    These findings suggest that autologous LSCT is effective in treating unilateral LSCD and is safe for the donor eye, regardless of the technique used. The study also demonstrates that SLET and CLAu have significantly better anatomic and functional success rates than CLET.