TY - JOUR
T1 - A systematic literature review of surgical interventions for limbal stem cell deficiency in humans
AU - Cauchi, Paul A.
AU - Ang, Ghee S.
AU - Azuara-Blanco, Augusto
AU - Burr, Jennifer M.
N1 - THE AUTHORS INDICATE NO FINANCIAL SUPPORT OR FINANCIAL CONFLICT OF INTEREST. INVOLVED IN DESIGN AND conduct of study (P.A.C., A.A.-B., J.M.B.); data collection (P.A.C., G.S.A.); management (P.A.C., A.A.-B., J.M.B.), analysis (P.A.C., G.S.A.), and interpretation of data (P.A.C., G.S.A., A.A.-B., J.M.B.); preparation of manuscript (P.A.C.); review of manuscript (A.A.-B., J.M.B.); and approval of
manuscript (P.A.C., G.S.A., A.A.-B., J.M.B.).
PY - 2008/8
Y1 - 2008/8
N2 - PURPOSE: To evaluate the relative benefits and to identify any adverse effects of surgical interventions for limbal stem cell deficiency (LSCD).DESIGN: Systematic literature review.METHODS: We searched the following electronic databases from January 1, 1989 through September 30, 2006: MEDLINE, EMBASE, Science citation index, BIOSIS, and the Cochrane Library. In addition, reference lists were scanned to identify any additional reports. The quality of published reports was assessed using standard methods. The main outcome measure was improvement in vision of at least two Snellen lines of best,corrected visual acuity (BCVA). Data on adverse outcomes also were collected.RESULTS: Twenty-six studies met the inclusion criteria. There were no randomized controlled studies. All 26 studies were either prospective or retrospective case series. For bilateral severe LSCD, keratolimbal allograft was the most common intervention with systemic immunosuppression. Other interventions included eccentric penetrating keratolimbal allografts and cultivated autologous oral mucosal epithelial grafts. An improvement in BCVA of two lines or more was reported in 31% to 67% of eyes. For unilateral severe LSCD, the most common surgical intervention was contralateral conjunctival limbal autograft, with 35% to 88% of eyes gaining an improvement in BCVA of two lines or more. The only study evaluating partial LSCD showed an improvement in BCVA of two lines or more in 39% of eyes.CONCLUSIONS: Studies to date have not provided strong evidence to guide clinical practice on which surgery is most beneficial to treat various types of LSCD. Standardized data collection in a multicenter LSCD register is suggested.
AB - PURPOSE: To evaluate the relative benefits and to identify any adverse effects of surgical interventions for limbal stem cell deficiency (LSCD).DESIGN: Systematic literature review.METHODS: We searched the following electronic databases from January 1, 1989 through September 30, 2006: MEDLINE, EMBASE, Science citation index, BIOSIS, and the Cochrane Library. In addition, reference lists were scanned to identify any additional reports. The quality of published reports was assessed using standard methods. The main outcome measure was improvement in vision of at least two Snellen lines of best,corrected visual acuity (BCVA). Data on adverse outcomes also were collected.RESULTS: Twenty-six studies met the inclusion criteria. There were no randomized controlled studies. All 26 studies were either prospective or retrospective case series. For bilateral severe LSCD, keratolimbal allograft was the most common intervention with systemic immunosuppression. Other interventions included eccentric penetrating keratolimbal allografts and cultivated autologous oral mucosal epithelial grafts. An improvement in BCVA of two lines or more was reported in 31% to 67% of eyes. For unilateral severe LSCD, the most common surgical intervention was contralateral conjunctival limbal autograft, with 35% to 88% of eyes gaining an improvement in BCVA of two lines or more. The only study evaluating partial LSCD showed an improvement in BCVA of two lines or more in 39% of eyes.CONCLUSIONS: Studies to date have not provided strong evidence to guide clinical practice on which surgery is most beneficial to treat various types of LSCD. Standardized data collection in a multicenter LSCD register is suggested.
KW - Ocular-Surface Disorders
KW - Amniotic Membrane Transplantation
KW - Penetrating Keratoplasty
KW - Keratolimbal Allograft
KW - Corneal Surface
KW - Autograft Transplantation
KW - Chronic Phases
KW - Reconstruction
KW - Burns
KW - Conjunctival
U2 - 10.1016/j.ajo.2008.03.018
DO - 10.1016/j.ajo.2008.03.018
M3 - Article
SN - 0002-9394
VL - 146
SP - 251
EP - 259
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
IS - 2
ER -