A systematic review of cellular therapies for the treatment of limbal stem cell deficiency affecting one or both eyes
Autor: | G. Rydevik, Jeffry Hogg, Arthur Okonkwo, Majlinda Lako, K. Wilson, Julie Glanville, F. Whiter, Gustavo S. Figueiredo, Francisco C Figueiredo, Mick Arber, E. Carr |
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Rok vydání: | 2021 |
Předmět: |
0301 basic medicine
Oncology medicine.medical_specialty Limbus Corneae Transplantation Autologous Corneal Diseases Limbal stem cell deficiency Cell therapy 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Limbal stem cell Oral mucosa Relative efficacy business.industry Stem Cells Epithelium Corneal Bayes Theorem Patient data Ophthalmology 030104 developmental biology medicine.anatomical_structure Data extraction 030221 ophthalmology & optometry Stem cell business Stem Cell Transplantation |
Zdroj: | The Ocular Surface. 20:48-61 |
ISSN: | 1542-0124 |
Popis: | Purpose This systematic review (SR) assessed the efficacy, safety and cost-effectiveness of cell-based therapy to manage limbal stem cell deficiency (LSCD), a sight-threatening orphan condition most frequently associated with severe chemical or thermal burns. LSCD has historically been treated by transplanting limbal tissue. In 1997, a new treatment, cultured limbal epithelial autografts, was described for unilateral LSCD. In cases of bilateral disease cultured autologous oral mucosa stem cells have been used. The relative efficacy of different cultured tissue procedures is unknown. Methods A protocol was registered with PROSPERO (CRD42017081117). Searches were conducted in 14 databases and 6 conference websites. Two reviewers independently selected studies, conducted data extraction and assessed risk of bias. One reviewer extracted individual patient data (IPD); a second checked extracted data. Data were assessed to determine the feasibility of statistical analysis, with Bayesian synthesis used to estimate improvement achieved by different treatments. Results Fifty-two studies were eligible for inclusion (1113 eyes); 41 studies (716 eyes) reported IPD. No evidence was identified on cost-effectiveness. This SR was unable to confirm that any of the types of ex vivo cultured stem cell transplants identified for LSCD treatment were statistically superior when assessed against the outcomes of interest. Conclusions We believe this SR is the first to include IPD analysis of LSCD data. There is no evidence for the superiority of any method of limbal stem cell transplant. Confirmation of the safety and efficacy of this treatment modality is challenging due to heterogeneity within and between the studies identified. Therefore, recommendations for future research are proposed. |
Databáze: | OpenAIRE |
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