Why Are Corneal Specialists Resistant to Treating Patients Who Have Severe Ocular Surface Disease With Limbal Stem Cell Deficiency?

Author:

Holland Edward J.1,Cheung Albert Y.2ORCID,Djalilian Ali R.3,Farid Marjan4,Mannis Mark J.5

Affiliation:

1. Cincinnati Eye Institute/University of Cincinnati, Cincinnati, OH;

2. Virginia Eye Consultants, Norfolk, VA;

3. The University of Illinois, College of Medicine, Chicago, IL;

4. Gavin Herbert Eye Institute, UC Irvine, Irvine, CA; and

5. UC Davis Health System Eye Center, Sacramento, CA.

Abstract

Purpose:To highlight the paucity of surgeons performing ocular surface stem cell transplantation with systemic immunosuppression (OSSTx with SI) for limbal stem cell deficiency (LSCD) patients, suboptimal treatments for LSCD, and obstacles to adoption.Methods:A review of the Eye Bank Association of America annual reports and the authors' case volume for OSSTx with SI was performed. Examination of the published literature on corneal surgeries, especially for LSCD, was completed. These findings were combined with our clinical observations to develop this editorial.Results:Despite techniques and protocols for OSSTx with SI published more than 30 years ago for the treatment of severe bilateral LSCD, only a small number of corneal specialists have adopted these techniques. There is a paucity of attention to this population of patients, with minimal publications to advance this area of our field. We are too often referred patients with LSCD and severe ocular surface disease that have had suboptimal treatments such as penetrating keratoplasties or primary keratoprostheses. Hesitancy for adopting OSSTx with SI is likely due to a lack of exposure to these procedures during training and fear of systemic immunosuppression. Corneal surgeons are likely unaware of the safety of systemic immunosuppression with appropriate monitoring especially when comanaging these patients with an organ transplant specialist.Conclusion:There is a large unmet need for the treatment of corneal blindness secondary to conjunctival and LSCD. For the vast majority of patients, OSSTx should be the first surgical choice to treat these eyes. We hope major ophthalmology centers will meet this need by building programs, and groups of corneal surgeons should collaborate to create regional centers to make this treatment more accessible to help this population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Ophthalmology

Reference75 articles.

1. Keratoepithelioplasty;Thoft;Am J Ophthalmol.,1984

2. Limbal autograft transplantation for ocular surface disorders;Kenyon;Ophthalmology,1989

3. Epithelial transplantation for the management of severe ocular surface disease;Holland;Trans Am Ophthalmol Soc.,1996

4. Epithelial stem-cell transplantation for severe ocular-surface disease;Holland;N Engl J Med.,1999

5. Keratolimbal allograft: recommendations for tissue procurement and preparation by eye banks, and standard surgical technique;Croasdale;Cornea,1999

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