Autologous limbal stem cell transplantation: a systematic review of clinical outcomes with different surgical techniques
| Autor: | Vivek Singh, Pragnya R. Donthineni, Swapna S Shanbhag, Sayan Basu, James Chodosh, Neda Nikpoor |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Visual acuity Limbal stem cell transplantation MEDLINE Limbus Corneae Transplantation Autologous Corneal Diseases Corneal Transplantation 03 medical and health sciences Cellular and Molecular Neuroscience 0302 clinical medicine Epidemiology medicine Humans Adverse effect business.industry Epithelium Corneal Sensory Systems Surgery Transplantation Ophthalmology Eye Burns 030104 developmental biology 030221 ophthalmology & optometry Secondary Outcome Measure Observational study medicine.symptom business Conjunctiva Stem Cell Transplantation |
| Zdroj: | The British journal of ophthalmology. 104(2) |
| ISSN: | 1468-2079 |
| Popis: | PurposeTo conduct a systematic review on outcomes of three different techniques of autologous limbal stem cell transplantation (LSCT): conjunctival-limbal autografting (CLAu), cultivated limbal epithelial transplantation (CLET) and simple limbal epithelial transplantation (SLET), in unilateral limbal stem cell deficiency (LSCD).MethodsLiterature searches were conducted in MEDLINE (Ovid), Embase, Web of Science and Cochrane Central Register. Standard systematic review methodology was followed using Meta-analysis of Observational Studies in Epidemiology guidelines. Studies with a sample size of more than 10 eyes were included. The primary outcome measure of efficacy was restoration of a completely epithelised, stable and avascular corneal surface (anatomical success). The secondary outcome measure of efficacy was improvement in best-corrected visual acuity of two-lines or greater (functional success).ResultsThe review identified 22 non-comparative case series, which included 1023 eyes. Ocular burns were the major (88%) indication for surgery. Overall, at a median postoperative follow-up of 1.75 years, autologous LSCT for unilateral LSCD showed anatomical and functional success rates of 69% and 60%, respectively, without any serious adverse events in the donor eye. The follow-up duration and indications for surgery were comparable across all groups (p>0.05). The anatomical and functional success rates of SLET (78%; 68.6%) and CLAu (81%; 74.4%) were comparable, and significantly better than those of CLET (61.4%; 53%; p=0.0048).ConclusionAutologous LSCT is a safe and effective treatment for unilateral LSCD. In the absence of randomised controlled trials, existing evidence clearly suggests that clinical outcomes are better with SLET and CLAu as compared with CLET. |
| Databáze: | OpenAIRE |
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