Surgical Management of Bilateral Limbal Stem Cell Deficiency

Abstract Limbal stem cell deficiency (LSCD) is now established as a distinct entity with a spectrum of clinical manifestations. Bilateral LSCD presents a unique set of challenges to the clinician dealing with ocular surface disease, due to the underlying causes, clinical presentation, and adnexal st...

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Bibliographic Details
Published in:The ocular surface 2016-07, Vol.14 (3), p.350-364
Main Authors: Vazirani, Jayesh, MS, Mariappan, Indumathi, PhD, Ramamurthy, Shreyas, MS, Fatima, Saba, MBBS, Basu, Sayan, MS, Sangwan, Virender, MS
Format: Article
Language:English
Subjects:
Boston KPro
Cornea
Corneal Diseases
cultivated oral mucosal epithelial transplantation
Epithelium, Corneal
Humans
keratoprosthesis
limbal stem cell deficiency
limbal stem cell transplantation
Limbus Corneae
LVP KPro
Ophthalmology
osteo-odonto keratoprosthesis
Prostheses and Implants
Stem Cells
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Summary:Abstract Limbal stem cell deficiency (LSCD) is now established as a distinct entity with a spectrum of clinical manifestations. Bilateral LSCD presents a unique set of challenges to the clinician dealing with ocular surface disease, due to the underlying causes, clinical presentation, and adnexal status, as well as lack of a source of autologous limbal stem cells. Various surgical modalities have been described to achieve visual rehabilitation in patients with bilateral LSCD. These can primarily be divided into cell-based therapies and implantation of keratoprostheses. In this review, the surgical options for management of bilateral LSCD, including autologous and allogeneic cell-based therapies and different types of keratoprostheses are described and classified. The indications, prerequisites, technique, results and complications of each modality are discussed. Based on the status of the ocular surface, an algorithm for choosing appropriate surgical management for vision restoration in bilateral LSCD has been proposed.
ISSN:1542-0124
1937-5913
DOI:10.1016/j.jtos.2016.02.006