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Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency

Limbal stem cell damage after chemical injury, autoimmune disorders or iatrogenic trauma leads to corneal conjunctivalisation with new vessel formation, epithelium instability and visual loss. Limbal stem cell transplantation includes reconstructive surgical procedures to restore a corneal epitheliu...

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Autores principales: Fernandez-Buenaga, Roberto, Aiello, Francesco, Zaher, Sarah S, Grixti, Andre, Ahmad, Sajjad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093197/
https://www.ncbi.nlm.nih.gov/pubmed/30123847
http://dx.doi.org/10.1136/bmjophth-2018-000164
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author Fernandez-Buenaga, Roberto
Aiello, Francesco
Zaher, Sarah S
Grixti, Andre
Ahmad, Sajjad
author_facet Fernandez-Buenaga, Roberto
Aiello, Francesco
Zaher, Sarah S
Grixti, Andre
Ahmad, Sajjad
author_sort Fernandez-Buenaga, Roberto
collection PubMed
description Limbal stem cell damage after chemical injury, autoimmune disorders or iatrogenic trauma leads to corneal conjunctivalisation with new vessel formation, epithelium instability and visual loss. Limbal stem cell transplantation includes reconstructive surgical procedures to restore a corneal epithelium. The recognised options are: conjunctival limbal autograft, in which stem cells are taken from the patient’s healthy eye; conjunctival limbal allograft, in which stem cells are taken from a living, related or dead donor and the keratolimbal allograft. Each of these procedures has some drawbacks; in particular, the conjunctival limbal autograft needs a relatively healthy fellow eye and needs a relatively large amount of donor tissue from the healthy eye (about one-third of the healthy limbal stem cell tissue) with potential risks to the donor eye. In the case of keratolimbal allograft transplants, the recipient needs an immunosuppressive treatment to reduce the risk of rejection with the associate possible side effects. More modern treatment options are reviewed. Cultivated oral mucosa epithelial transplantation success rate can vary between 50% and 70% at 3–4 years of follow-up. Simple limbal epithelial transplantation results show a success rate from 75.2% to 83.8% after 1 year of follow-up. Inclusion criteria for autologous cultivated limbal epithelial transplantation as approved by the National Institute of Health and Care Excellence are also shown in this paper. On the basis of these more contemporary treatment options, a stepladder approach to evaluate which procedure is most appropriate and personalised to the patient’s conditions is proposed.
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spelling pubmed-60931972018-08-17 Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency Fernandez-Buenaga, Roberto Aiello, Francesco Zaher, Sarah S Grixti, Andre Ahmad, Sajjad BMJ Open Ophthalmol Review Limbal stem cell damage after chemical injury, autoimmune disorders or iatrogenic trauma leads to corneal conjunctivalisation with new vessel formation, epithelium instability and visual loss. Limbal stem cell transplantation includes reconstructive surgical procedures to restore a corneal epithelium. The recognised options are: conjunctival limbal autograft, in which stem cells are taken from the patient’s healthy eye; conjunctival limbal allograft, in which stem cells are taken from a living, related or dead donor and the keratolimbal allograft. Each of these procedures has some drawbacks; in particular, the conjunctival limbal autograft needs a relatively healthy fellow eye and needs a relatively large amount of donor tissue from the healthy eye (about one-third of the healthy limbal stem cell tissue) with potential risks to the donor eye. In the case of keratolimbal allograft transplants, the recipient needs an immunosuppressive treatment to reduce the risk of rejection with the associate possible side effects. More modern treatment options are reviewed. Cultivated oral mucosa epithelial transplantation success rate can vary between 50% and 70% at 3–4 years of follow-up. Simple limbal epithelial transplantation results show a success rate from 75.2% to 83.8% after 1 year of follow-up. Inclusion criteria for autologous cultivated limbal epithelial transplantation as approved by the National Institute of Health and Care Excellence are also shown in this paper. On the basis of these more contemporary treatment options, a stepladder approach to evaluate which procedure is most appropriate and personalised to the patient’s conditions is proposed. BMJ Publishing Group 2018-08-10 /pmc/articles/PMC6093197/ /pubmed/30123847 http://dx.doi.org/10.1136/bmjophth-2018-000164 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Review
Fernandez-Buenaga, Roberto
Aiello, Francesco
Zaher, Sarah S
Grixti, Andre
Ahmad, Sajjad
Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency
title Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency
title_full Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency
title_fullStr Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency
title_full_unstemmed Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency
title_short Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency
title_sort twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093197/
https://www.ncbi.nlm.nih.gov/pubmed/30123847
http://dx.doi.org/10.1136/bmjophth-2018-000164
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