A Systematic Literature Review of Surgical Interventions for Limbal Stem Cell Deficiency in Humans

• Published in: American journal of ophthalmology Vol. 146; no. 2; pp. 251 - 259.e2
• Main Authors: Cauchi, Paul A, Ang, Ghee S, Azuara-Blanco, Augusto, Burr, Jennifer M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2008; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Cells, Cultured; Clinical trials; Conjunctival Diseases - surgery; Corneal Diseases - surgery; Epithelial Cells - transplantation; Epithelium, Corneal - transplantation; Humans; Intervention; Limbus Corneae - pathology; Literature reviews; Medical prognosis; Medical sciences; Medical treatment; Miscellaneous; Ophthalmology; Stem Cell Transplantation; Stem cells; Stem Cells - pathology; Studies; Transplants & implants; Human; Literature; Treatment; Stem cell; Surgery; Deficiency; Rim of sclera; Evidence-based practice; Systematic review; Ophthalmology; Evidence-based medicine
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2008.03.018

Purpose To evaluate the relative benefits and to identify any adverse effects of surgical interventions for limbal stem cell deficiency (LSCD). Design Systematic literature review. Methods We searched the following electronic databases from January 1, 1989 through September 30, 2006: MEDLINE, EMBASE, Science citation index, BIOSIS, and the Cochrane Library. In addition, reference lists were scanned to identify any additional reports. The quality of published reports was assessed using standard methods. The main outcome measure was improvement in vision of at least two Snellen lines of best-corrected visual acuity (BCVA). Data on adverse outcomes also were collected. Results Twenty-six studies met the inclusion criteria. There were no randomized controlled studies. All 26 studies were either prospective or retrospective case series. For bilateral severe LSCD, keratolimbal allograft was the most common intervention with systemic immunosuppression. Other interventions included eccentric penetrating keratolimbal allografts and cultivated autologous oral mucosal epithelial grafts. An improvement in BCVA of two lines or more was reported in 31% to 67% of eyes. For unilateral severe LSCD, the most common surgical intervention was contralateral conjunctival limbal autograft, with 35% to 88% of eyes gaining an improvement in BCVA of two lines or more. The only study evaluating partial LSCD showed an improvement in BCVA of two lines or more in 39% of eyes. Conclusions Studies to date have not provided strong evidence to guide clinical practice on which surgery is most beneficial to treat various types of LSCD. Standardized data collection in a multicenter LSCD register is suggested.