Review Article

Limbal Stem Cell Deficiency: Current Treatment Options and Emerging Therapies

Table 3

Culture methods and clinical results of published CLET reports.

Patients Type of graftSubstrate 3T3s
used
Animal Free
culturing conditions
GMP Success rate2-line visual improvement Subsequent surgery ComplicationsFollow-up (months)
MeanRange

Ang et al. [38]1AllograftHAM (denuded)++100% (1/1)0% (0/1)48

Baradaran-Rafii et al. [45]8AutograftHAM (denuded)88% (7/8)63% (7/8)KP (4)Perforation (1)346–48

Basu et al. [55]50AutograftHAM+66% (33/50)76% (38/50)KP (8)Bleeding (23), bacterial keratitis (1)2812–90

Daya et al. [34]10Allograft3T3s+70% (7/10)33% (3/9)KP (5), cataract (1), KLAL (5)Infective keratitis (1)2812–50

Di Girolamo et al. [43]2AutograftSiloxane Hydrogel CL100% (2/2)50% (1/2) 10.58–13

Di Iorio et al. [48]166AutograftFibrin+80% (133/166)KP (33)>6

Fatima et al. [41]1AutograftHAM100% (1/1)100% (1/1)KP (1)37

Gisoldi et al. [46]6AutograftFibrin++83% (5/6)83% (5/6)KP (4), cataract (1)2411–34

Grueterich et al. [29]1AutograftHAM100% (1/1)100% (1/1)KP (1), cataract (1)21

Kawashima et al. [40]6Autograft (2), allograft (4)HAM (denuded)++100% (6/6)67% (4/6)KP (6), cataract (5)CRVO (1)3220–44

Koizumi et al. [26]13AllograftHAM (denuded)++77% (10/13)38% (5/13)Rejection (3), infection (1), conjunctival invasion (2), conjunctival fibrosis (1)116–13

Koizumi et al. [27]3AllograftHAM (denuded)++100% (3/3)0% (0/2)6

Kolli et al. [50]8AutograftHAM+100% (8/8)63% (5/8)KP (1), graft redo (1)1912–30

Meller et al. [44]1AllograftHAM100% (1/1)100% (1/1)Perforation (1)31

Nakamura et al. [32]3AllograftHAM (denuded)++100% (3/3)33% (1/3)1312–14

Nakamura et al. [33]1AutograftHAM (denuded)++100% (1/1)100% (1/1)19

Nakamura et al. [36]9Autograft (2), allograft (7)HAM (denuded)++100% (9/9)67% (6/9)Infective keratitis (1)14.66–20

Pathak et al. [58]9AutograftHAM +56% (5/9)33% (3/9)KP (1), graft redo (1), AMT (1)18.511–24

Pauklin et al. [51]44Autograft (30), allograft (14)HAM68% (30/44)73% (32/44)KP (8), cataract (5)Bleeding (1), perforation (2)28.59–72

Pellegrini et al. [22]2Autograft3T3s+100% (2/2)50% (1/2)KP (1)>24

Prabhasawat et al. [54]19Autograft (12), allograft (7)Ham (denuded)+73.7% (14/19)68.4% (13/19)KP (6), lid correction (3), cataract (3), tarsorrhaphy (1)Infection (3), PED (3), symblepharon (1)26.16–47

Rama et al. [28]18AutograftFibrin+78% (14/18)33% (6/18)KP (3)Persistent inflammation with bleeding (4)17.512–72

Rama et al. [49]107AutograftFibrin++68% (73/107)54% (61/107)KP (62), PTK (2)Bleeding (12), inflammation (59), herpetic keratitis (3), blepharitis/epitheliopathy (35), residual fibrin (11)3512–120

Sangwan et al. [31]2AutograftHAM100% (2/2)50% (1/2)Recurrence (1)12

Sangwan et al. [31]15Autograft (11), allograft (4)HAM100% (15/15)87% (13/15)KP (15)Rejection (4), glaucoma (1)15.37–24

Sangwan et al. [37]78AutograftHAM73% (57/78)37% (18/49)KP (19)Phthisis (2), keratitis (2), glaucoma (2)18.33–40

Sangwan et al. [52]200AutograftHam (denuded)+71% (142/200)60.5% (121/200)Bleeding (56), PED (13), corneal melting (5), bacterial keratitis (3)3612–91

Schwab [23]19Autograft (17), allograft (2)HAM+74% (14/19)16% (3/19)Graft redo (1)10.52–24

Schwab et al. [24]14Autograft (10), allograft (4)HAM (denuded)++71% (10/14)36% (5/14)KP (1)Epithelial loss (1), cyclosporine-related (2), infectious keratitis (1), pyogenic granuloma (1)136–19

Sejpal et al. [57]107AutograftHAM (denuded)+49.5% (53/107)54.2% (58/107)KP (19), lid or fornix correction (16)Infection (7), inflammatory granuloma (4), glaucoma (1), corneal thinning (1), bleeding (1), panophthalmitis (1)41.212–118

Sharma et al. [53]50Autograft (34), allograft (16)HAM (denuded)74% (37/50)68% (34/50)KP (4)111.5–25

Shimazaki et al. [30]13AllograftHAM (denuded)38.5% (5/13)76.9% (10/13)Perforation (4), infection (2)

Shimazaki et al. [39]27Autograft (7), allograft (20)HAM (denuded)+59% (16/27)48% (13/27)KP (8), limbal transplant (3)Infection (1), ulceration (4), perforation (4)29.36–85

Shortt et al. [42]16Autograft (9), allograft (7)HAM (denuded)+75% (12/16)22% (2/9)Graft redo (1)Infection (1), cyclosporin related (1), graft detachment (1)9.36–13

Subramaniam et al. [56]40AutograftHAM (denuded)45% (18/40)KP (10)33.41–87

Thanos et al. [47]1AutologousHAM100% (1/1)100% (1/1)24

Tsai et al. [25]6Autograft (3), allograft (3)HAM (denuded)100% (6/6)50% (3/6)1512–18

Vazirani et al. [60]70AutograftHAM (denuded)71% (49/70)17.5

Zakaria et al. [59]18Autograft (15), allograft (3)HAM (denuded)++67% (12/18)28% (5/18)KP (7)244–48

Overall1164Autograft (1029), allograft (135)70.26%54.92%25.41–120

GMP: good manufacturing practice; HAM: human amniotic membrane; CL: contact lens; KP: keratoplasty; AMT: amnion membrane transplantation; PTK: phototherapeutic keratectomy; CRVO: central retinal vein occlusion; PED: persistent epithelial defect.