Sophie X Deng1, Friedrich Kruse2, José A P Gomes3, Clara C Chan4, Sheraz Daya5, Reza Dana6, Francisco C Figueiredo7, Shigeru Kinoshita8, Paolo Rama9, Virender Sangwan10, Allan R Slomovic4, Donald Tan11. 1. Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA. 2. Department of Ophthalmology, University Hospital Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. 3. Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil. 4. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. 5. Centre for Sight, East Grinstead, United Kingdom. 6. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA. 7. Department of Ophthalmology, Royal Victoria Infirmary and Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom. 8. Kyoto Prefectural University of Medicine, Kyoto, Japan. 9. Istituto Scientifico San Raffaele, Milano, Italy. 10. Dr. Shroff's Charity Eye Hospital, New Delhi, India; and. 11. Singapore Eye Research Institute, Singapore, Singapore.
Abstract
PURPOSE: In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD. METHODS: An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study. RESULTS: A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo-cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established. CONCLUSIONS: This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.
PURPOSE: In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD. METHODS: An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study. RESULTS: A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo-cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established. CONCLUSIONS: This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.
Authors: Clémence Bonnet; Andrew Lee; Vivian P Shibayama; Chi-Hong Tseng; Sophie X Deng Journal: Cont Lens Anterior Eye Date: 2021-10-30 Impact factor: 3.946
Authors: Katarzyna Krysik; Piotr Miklaszewski; Dariusz Dobrowolski; Anita Lyssek-Boroń; Beniamin O Grabarek; Edward Wylęgała Journal: Ophthalmol Ther Date: 2021-11-22
Authors: Clémence Bonnet; Sheyla González; JoAnn S Roberts; Sarah Y T Robertson; Maxime Ruiz; Jie Zheng; Sophie X Deng Journal: Prog Retin Eye Res Date: 2021-03-04 Impact factor: 21.198