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  • Limbal stem cell transplantation appears suited for severe ocular surface disorders

    Cornea/External Disease

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    This is the largest study to examine long-term outcomes following allogenic ocular surface stem cell transplantation (OSST) for limbal stem cell deficiency (LSCD).

    Study design

    Investigators reviewed 165 eyes of 110 patients with total LSCD who underwent ocular surface stem cell transplantation (OSST) by a single surgeon. Procedures included keratolimbal allograft, conjunctival-limbal autograft and others, with a follow-up of at least 5 years. The primary indications for the procedure were congenital aniridia, chemical/thermal burns, and Stevens Johnson Syndrome (SJS). The authors examined both ocular surface stability and BCVA.

    Outcomes

    Over 70% of all patients achieved ocular surface stability by the end of follow-up, defined as lack of diffuse staining, corneal conjunctivalization or persistent epithelial defects. When sorted by indication for OSST, eyes with aniridia showed the highest success rate (73.1%), followed by chemical/thermal injury (70.3%). BCVA improved by 2 or more lines in 62% of patients.

    Of note, about 65% of eyes underwent concurrent keratoplasty, and over half of these grafts failed. All eyes underwent systemic immunosuppression, with 32% of eyes having at least 1 acute episode of rejection.

    Of the 51 eyes that required additional OSST surgery, 56.9% achieved a stable ocular surface.

    Limitations

    The study is limited by its retrospective nature that may have introduced potentially confounding variation in the underlying diagnoses and clinical presentations. The treatment modalities also differed greatly, making definitive conclusions difficult. Though all procedures were performed by a single surgeon, the technique implemented varied over the course of the study.

    Clinical significance

    This study uniquely demonstrates that good long-term results can be achieved with OSST for limbal cell deficiency, despite the rigors of systemic immunosuppression necessary for managing the chronic underlying conditions. Allograft OSST should be considered as a therapeutic option for certain severe ocular surface disorders.