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Review
.2016:2016:9798374.
doi: 10.1155/2016/9798374. Epub 2015 Dec 14.

Limbal Stem Cell Deficiency: Current Treatment Options and Emerging Therapies

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Review

Limbal Stem Cell Deficiency: Current Treatment Options and Emerging Therapies

Michel Haagdorens et al. Stem Cells Int.2016.

Abstract

Severe ocular surface disease can result in limbal stem cell deficiency (LSCD), a condition leading to decreased visual acuity, photophobia, and ocular pain. To restore the ocular surface in advanced stem cell deficient corneas, an autologous or allogenic limbal stem cell transplantation is performed. In recent years, the risk of secondary LSCD due to removal of large limbal grafts has been significantly reduced by the optimization of cultivated limbal epithelial transplantation (CLET). Despite the great successes of CLET, there still is room for improvement as overall success rate is 70% and visual acuity often remains suboptimal after successful transplantation. Simple limbal epithelial transplantation reports higher success rates but has not been performed in as many patients yet. This review focuses on limbal epithelial stem cells and the pathophysiology of LSCD. State-of-the-art therapeutic management of LSCD is described, and new and evolving techniques in ocular surface regeneration are being discussed, in particular, advantages and disadvantages of alternative cell scaffolds and cell sources for cell based ocular surface reconstruction.

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Figures

Figure 1
Figure 1
(A) Overview of the anterior surface of the human eye, in which the sclera (with overlying conjunctiva) and cornea can easily be discriminated. (B) The limbus is highly pigmented in some individuals, and allows clear visualization of the limbal palisades of Vogt. The cornea (and underlying dark iris) is pictured above, and conjunctiva (and underlying sclera) below. (C) Diagram of a cross section through the conjunctival, limbal and corneal epithelium. Limbal progenitor cells (a) differentiate into transient amplifying cells (b), post-mitotic cells (c) and finally terminally differentiated cells (d). Movement of cells in X, Y, Z direction is presented by proliferation of stem cells(a), differentiation and centripetal migration (b, c), and desquamation (d) respectively.
Figure 2
Figure 2
Haematoxylin staining of cross section through normal limbal region. Arrow in (a) indicates a LESC containing limbal epithelial crypt; arrowheads indicate blood vessels. Arrow in (b) indicates a limbal crypt, flanked by two focal stromal projections (arrowhead).
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