Copyright ©The Author(s) 2023.
World J Transplant. Dec 18, 2023; 13(6): 321-330
Published online Dec 18, 2023. doi: 10.5500/wjt.v13.i6.321
Table 1 Causes of limbal stem cell deficiency
Genetic disease
Acquired immune-mediated
Acquired nonimmune-mediated
Congenital aniridiaSteven-Johnson syndromeChemical/thermal injuryOcular surface tumors
Keratitis ichthyosis deafness syndromeToxic necrolysisRadiation injuryDrug-induced LSCD
Xeroderma pigmentosumMucous membrane pemphigoidContact lens wearIdiopathic
Ectrodactyly-ectodermal dysplasia-clefting syndromeVernal/atopic keratoconjunctivitisMultiple limbal surgeries
Dyskeratosis congenitaGraft-vs-host diseaseBullous keratopathy
Peter’s anomalyChronic lid diseases
Infectious ocular diseases
Table 2 Stages of limbal stem cell deficiency

ICentral 5 mm of cornea not involvedLimbus involvement < 50%Limbus involvement > 50% but < 100%Limbus entirely involved
IICentral 5 mm of cornea involvedLimbus involvement < 50%Limbus involvement > 50% but < 100%
IIIThe entire corneal surface involved
Table 3 Common surgical techniques for limbal stem cell deficiency
Tissue origin
Direct transplantation
Conjunctival limbal autograftCLAUPatient
Living-related conjunctival allograftlr-CLALRelative donor
Keratolimbal allograftKLALCadaveric donor
Cincinnati procedureRelative/cadaveric donor
Modified Cincinnati procedurePatient/cadaveric donor
Stem cells transplantation
Simple limbal epithelium transplantationSLETPatient
Tissue engineering
Cultured limbal epithelial transplantationCLETPatient/living donor
Autologous conjunctival epithelial cells cultivated ex vivoEVCAUPatient
Cultivated oral mucosa epithelial transplantationCOMETPatient