Cultivated Limbal Stem Cell Transplantation for Ocular Surface Reconstruction: A Systematic Review and Meta-Analysis

Abstract

Introduction: Limbal stem cell deficiency (LSCD) leads to corneal opacification and vision loss. Transplantation of cultivated limbal epithelial stem cells (LESCs) is a regenerative strategy to restore the corneal surface. This review evaluates the success and safety of this technique. Methods: A systematic literature search was performed in MEDLINE and Web of Science for studies reporting outcomes of cultivated LESC transplantation. The primary outcome was a stable, epithelialized corneal surface. The secondary outcome was an improvement in visual acuity. Results: Forty-five studies with 1,850 eyes were included. The pooled success rate for achieving a stable corneal surface was 76% (95% CI: 71-81%). A significant improvement in visual acuity of two or more Snellen lines was achieved in 65% of successful cases. Complications included persistent epithelial defects and infection. Discussion: Cultivated LESC transplantation is an effective treatment for LSCD. Success is dependent on the severity of the deficiency and the presence of underlying inflammation. The use of amniotic membrane as a carrier substrate is well-established. Conclusion: LESC transplantation is the standard of care for severe LSCD, effectively restoring the ocular surface and improving vision in the majority of patients.