title: Management of Limbal Stem Cell Deficiency: A Historical Perspective, Past, Present, and Future.
abstract: OBJECTIVE
  To review the management of limbal stem cell deficiency (LSCD) from a historical perspective, report the current treatment guidelines, and propose potential future treatments.
  
  
  METHODS
  A literature review was conducted to identify key publications regarding the management of LSCD since treatments were first reported. The advances in surgical treatments, as well as postoperative management, are described from a historical perspective. In addition, current treatment guidelines, as well as future management strategies, are discussed.
  
  
  RESULTS
  The management of LSCD has changed dramatically during the last several decades. Before the understanding of the anatomy and physiology of the limbus, all patients with severe LSCD had a dismal prognosis. It was not until the understanding of the location and function of the limbal stem cells that successful management protocols could be formulated. This research gave rise to medical and surgical treatment that protected or replaced diseased or absent limbal stem cells. Understanding the role of the conjunctiva in severe ocular surface disease was also critical in the management of LSCD. Continued improvement in tissue harvesting and surgical techniques have led to improved outcomes in LSCD patients.
  
  
  CONCLUSIONS
  Significant progress has been made during the last several decades to manage patients with LSCD. A substantial percent of patients can achieve improved visual acuity with current techniques. Continued research with new cell culture and tissue engineering techniques may be the next breakthrough to improve the outcomes for these most challenging patients.
authors.affiliation: Cincinnati Eye Institute, University of Cincinnati, Cincinnati OH.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Holland
mesh_terms: D018929:Cell Culture Techniques; D002478:Cells, Cultured; D003228:Conjunctiva / Q000166:cytology; D003316:Corneal Diseases / Q000628:therapy*; D004847:Epithelial Cells / Q000637:transplantation*; D019573:Epithelium, Corneal / Q000166:cytology*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology*; D033581:Stem Cell Transplantation / Q000266:history* / Q000639:trends*; D013234:Stem Cells / Q000473:pathology*; D014182:Transplantation, Autologous