title: 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 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.
authors.affiliation: Cornea and Anterior Segment Services, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India.
authors.forename: Jayesh
authors.initials: J
authors.lastname: Vazirani
authors.affiliation: Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Indumathi
authors.initials: I
authors.lastname: Mariappan
authors.affiliation: Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Shreyas
authors.initials: S
authors.lastname: Ramamurthy
authors.affiliation: Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Saba
authors.initials: S
authors.lastname: Fatima
authors.affiliation: Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, L V Prasad Eye Institute, Hyderabad, India; Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Sayan
authors.initials: S
authors.lastname: Basu
authors.affiliation: Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, L V Prasad Eye Institute, Hyderabad, India; Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, India. Electronic address: vsangwan@lvpei.org.
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D003315:Cornea; D003316:Corneal Diseases; D019573:Epithelium, Corneal; D006801:Humans; D016850:Limbus Corneae; D019736:Prostheses and Implants; D013234:Stem Cells
keywords: Boston KPro; LVP KPro; cultivated oral mucosal epithelial transplantation; keratoprosthesis; limbal stem cell deficiency; limbal stem cell transplantation; osteo-odonto keratoprosthesis