Abstrait

Limbal stem cell transplants and amniotic membrane grafts in ocular surface disease: current perspectives.

Ashok Sharma, Rajan Sharma

Limbal stem cells (LSC) play pivotal role in corneal epithelial cell homeostasis and corneal epithelial healing. In addition to corneal epithelial cell regeneration, LSC act as barrier, preventing conjunctival epithelial cells to grow on to the cornea. Limbal stem cell deficiency (LSCD) may occur following trauma, immune mediated diseases, repeated surgical procedures at limbus and genetic diseases. Chemical eye injury remains the most frequent cause of LSCD. LSCD leads to conjunctivilization, corneal vascularization, recurrent erosions and corneal opacification. LSCD is best addressed with surgical procedure, limbal stem cell transplantation (LSCT). Uniocular LSCD is treated with autologus LSCT and bilateral LSCD with live-related LSCT or cadaveric LSCT. Recently cultivated limbal stem cell transplants (CLSCT) have been used to rehabilitate damaged ocular surface. Cultivated oral mucosal epithelial cell have also been used successfully to reconstruct the ocular surface. More recently, simple limbal epithelial cell transplantation (SLET) has been introduced to treat LSCD. The technique is simple, inexpensive and does not require elaborate laboratory set up. Following LSCT dry eye, glaucoma, eyelid abnormalities and ocular surface inflammation should be addressed. Inflammation is detrimental to the survival of LSC. Thus ocular surface inflammation should be kept minimum using topical or systemic corticosteroid or immune suppressants. Results of LSCT in inflammatory disorders including Stevens-Johnson syndrome and ocular cicatricial pemphigoid are less favorable. AMG and LSCT have revolutionized the ocular surface disease management.