Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 18, 2023; 13(6): 321-330
Published online Dec 18, 2023. doi: 10.5500/wjt.v13.i6.321
Focus on limbal stem cell deficiency and limbal cell transplantation
Emanuele Tonti, Gregorio Antonio Manco, Leopoldo Spadea, Marco Zeppieri
Emanuele Tonti, Gregorio Antonio Manco, Leopoldo Spadea, Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Author contributions: Tonti E wrote the outline, did the research, wrote the paper, and provided the final approval of the version of the article; Manco GA assisted in the editing and making critical revisions of the manuscript; Spadea L assisted in the writing, editing, and making critical revisions of the manuscript; Zeppieri M assisted in the conception and design of the study, and writing, outline, and final approval of the version of the article to be published and completed the English and scientific editing (a native English speaker).
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior authors or other coauthors who contributed their efforts to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Marco Zeppieri, BSc, MD, PhD, Doctor, Department of Ophthalmology, University Hospital of Udine, No. 15 p.le S. Maria della Misericordia, Udine 33100, Italy.
Received: September 19, 2023
Peer-review started: September 19, 2023
First decision: October 9, 2023
Revised: October 10, 2023
Accepted: November 2, 2023
Article in press: November 2, 2023
Published online: December 18, 2023

Limbal stem cell deficiency (LSCD) causes severe vision impairment and can lead to blindness, representing one of the most challenging ocular surface disorders. Stem cell deficiency can be congenital or, more often, acquired. The categorization of ocular surface transplantation techniques is crucial to achieving treatment homogeneity and quality of care, according to the anatomic source of the tissue being transplanted, genetic source, autologous or allogenic transplantation (to reflect histocompatibility in the latter group), and cell culture and tissue engineering techniques. The aim of this minireview is to provide a summary of the management of LSCD, from clinical characteristics and therapeutic outcomes to the development of novel therapeutic approaches. The manuscript also briefly summarizes recent findings in the current literature and outlines the future challenges to overcome in the management of the major types of ocular surface failure.

Keywords: Limbal stem cell deficiency, Conjunctival limbal autograft, Conjunctival limbal allograft, Keratolimbal allograft, Cultivated limbal epithelial transplantation, Simple limbal epithelial transplantation

Core Tip: Limbal cell transplantation has been developed for the management of limbal stem cell (LSC) deficiency, to improve this condition and related complications, ameliorating visual acuity and quality of life of affected patients. Some of the limitations include the lack of specific markers and standardized methods to identify LSCs, as well as the need to standardize the choice of therapeutic options which have diversified over the years and have evolved in terms of technology, efficacy, and safety. This clinical update review is to enable clinicians with the best evidence and current recommendations for managing their patients within the most advanced limbal cell transplant techniques.