[Surgical approaches for limbal stem cell deficiency].
BACKGROUND
Stem cells are the ultimate source of the rapidly self-renewing corneal epithelium and are located in the basal layer of the limbal epithelium. A variety of diseases can compromise the stem cell pool, causing an entity called limbal stem cell deficiency. Several therapeutic strategies should be taken into account.


RESULTS
Ocular surface defence should be restored prior to any kind of stem cell transplantation to assure a sufficient and stable tearfilm. Surgical strategies comprise superficial keratectomy with or without amniotic membrane transplantation, conjunctival-limbal autograft and keratolimbal allograft transplantation. A damaged limbal and corneal stroma can be reconstructed by amniotic membrane as a biological substrate. First encouraging results have been reported using tissue bio-engineered limbal epithelium on amniotic membrane for corneal surface reconstruction.


CONCLUSIONS
The correct diagnosis and a restored ocular surface defence are a prerequisite for subsequent transplantation of limbal stem cells. Optimal patient selection for the respective surgical approach and systemic immunosuppression protocols to improve allograft survival need to be further investigated.
Grüterich
Martin
M
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Fl, USA.
Tseng
Scheffer C G
SC
D002452:Cell Count; D003228:Conjunctiva / Q000473:pathology; D003316:Corneal Diseases / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D019573:Epithelium, Corneal / Q000473:pathology; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology*; D033581:Stem Cell Transplantation / Q000379:methods*; D013234:Stem Cells / Q000473:pathology*; D023822:Tissue Engineering