Limbal Stem Cell Transplant | PristynCare

Risk Factors

Patients most at risk for limbal stem cell deficiency include:

• Survivors of chemical burns to the eye
• Patients with Stevens-Johnson syndrome or ocular pemphigoid
• Those with aniridia or hereditary LSCD
• Patients with a history of multiple ocular surgeries or cryotherapy
• Contact lens over-wearers with limbal complications

Who is Eligible

Patients with partial or total limbal stem cell deficiency causing persistent corneal surface failure, vascularization, and vision loss are eligible for LSCT. Candidates must have adequate tear film function and, for allogeneic procedures, the ability to tolerate systemic immunosuppression. Pre-operative amniotic membrane grafting may be required to prepare the ocular surface.

Diagnosis

Diagnosis of limbal stem cell deficiency involves:

• Slit-lamp examination for corneal vascularization and epithelial irregularity
• Impression cytology to detect goblet cells on the corneal surface (conjunctivalization)
• Corneal fluorescein staining to map epithelial defects
• In vivo confocal microscopy for limbal stem cell assessment
• Anterior segment OCT to assess corneal thickness and surface structure

Treatment Plan

Treatment begins with medical stabilization of the ocular surface using lubricants, autologous serum drops, and anti-inflammatory agents. Once the surface is stable, LSCT is performed. Post-operatively, patients require topical immunosuppression and systemic cyclosporine or mycophenolate for allogeneic grafts. Amniotic membrane transplantation often accompanies or precedes LSCT to support the graft.

Limbal Stem Cell Transplant Steps

The LSCT surgical procedure involves:

• Pre-operative preparation of the recipient ocular surface with amniotic membrane if needed
• Anesthesia – general or local with sedation
• Removal of fibrovascular pannus and diseased epithelium from the recipient cornea
• Harvesting of limbal tissue from the donor eye (autograft) or cadaveric tissue (allograft)
• Placement of limbal grafts around the recipient limbus at multiple meridian positions
• Amniotic membrane overlay to protect the graft and promote healing
• A bandage contact lens or tarsorrhaphy may be used to support healing
• Post-operative topical steroids, cyclosporine, and antibiotics are started immediately

Post-Operative Recovery

Recovery after limbal stem cell transplantation requires:

• Long-term topical cyclosporine eye drops to prevent rejection
• Systemic immunosuppression for allogeneic grafts (cyclosporine, MMF)
• Avoid rubbing the eyes or wearing contact lenses
• Regular follow-up every 1 to 2 months in the first year
• Lubricating eye drops and autologous serum for surface support
• Corneal transplantation (PK or DSEK) may be planned later once the surface is stable

Risks and Complications of Limbal Stem Cell Transplant

Complications after LSCT include:

• Graft rejection: Particularly with allogeneic grafts; treated with intensified immunosuppression
• Primary failure: Non-engraftment of transplanted stem cells
• Persistent epithelial defects: Prolonged surface healing despite transplant
• Infection: Bacterial or fungal keratitis in the post-operative period
• Immunosuppression side effects: Systemic risks from long-term cyclosporine or MMF use
• Recurrence of LSCD: Graft loss over time, especially in inflammatory conditions