Global Consensus on the Management of Limbal Stem Cell Deficiency

Sophie X. Deng; Friedrich Kruse; José A. P. Gomes; Clara C. Chan; Sheraz Daya; Reza Dana; Francisco C. Figueiredo; Shigeru Kinoshita; Paolo Rama; Virender Sangwan; Allan R. Slomovic; Donald Tan

doi:10.1097/ico.0000000000002358

journal article Jul 03, 2020

Global Consensus on the Management of Limbal Stem Cell Deficiency

Sophie X. Deng Friedrich Kruse José A. P. Gomes Clara C. Chan Sheraz Daya Reza Dana

Francisco C. Figueiredo

Shigeru Kinoshita

Paolo Rama Virender Sangwan Allan R. Slomovic Donald Tan

Cornea Vol. 39 No. 10 pp. 1291-1302 · Ovid Technologies (Wolters Kluwer Health)

View at Publisher Save 10.1097/ico.0000000000002358

Abstract

Purpose:
In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD.

Methods:
An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study.

Results:
A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo–cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established.

Conclusions:
This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.

Topics

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Details

Published: Jul 03, 2020
Vol/Issue: 39(10)
Pages: 1291-1302

Authors

S

Sophie X. Deng

Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA;

F

Friedrich Kruse

Department of Ophthalmology, University Hospital Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany;

J

José A. P. Gomes

Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil;

C

Clara C. Chan

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada;

S

Sheraz Daya

Centre for Sight, East Grinstead, United Kingdom;

R

Reza Dana

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA;

F

Francisco C. Figueiredo

Department of Ophthalmology, Royal Victoria Infirmary and Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom;

S

Shigeru Kinoshita

Kyoto Prefectural University of Medicine, Kyoto, Japan;

P

Paolo Rama

Istituto Scientifico San Raffaele, Milano, Italy;

V

Virender Sangwan

Dr. Shroff's Charity Eye Hospital, New Delhi, India; and

A

Allan R. Slomovic

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada;

D

Donald Tan

Singapore Eye Research Institute, Singapore, Singapore.

Cite This Article

Sophie X. Deng, Friedrich Kruse, José A. P. Gomes, et al. (2020). Global Consensus on the Management of Limbal Stem Cell Deficiency. Cornea, 39(10), 1291-1302. https://doi.org/10.1097/ico.0000000000002358

Global Consensus on the Management of Limbal Stem Cell Deficiency

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