Global Consensus on the Management of Limbal Stem Cell Deficiency

International Limbal Stem Cell Deficiency Working Group

doi:10.1097/ICO.0000000000002358

Global Consensus on the Management of Limbal Stem Cell Deficiency

International Limbal Stem Cell Deficiency Working Group

Ophthalmology & Visual Neurosciences

Research output: Contribution to journal › Article › peer-review

126 Scopus citations

Abstract

Purpose: In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD. Methods: An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study. Results: A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo-cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established. Conclusions: This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.

Original language	English (US)
Pages (from-to)	1291-1302
Number of pages	12
Journal	Cornea
Volume	39
Issue number	10
DOIs	https://doi.org/10.1097/ICO.0000000000002358
State	Published - 2020

Bibliographical note

Funding Information:
S. X. Deng receives funding from the National Eye Institute (2R01EY021797) and California Institute for Regenerative Medicine (CLIN1-08686; CLIN2-11650) and is a consultant for F-Prime Capital, W. L. Gore & Associates, Inc, Kowa Research Institute, Inc, and Dompé US. F. Kruse is a consultant for Kowa Research Institute, Inc. C. C. Chan received honoraria previously from Alcon Labs Inc, Allergan, Bausch & Lomb, Santen, Shire, Thea, Labtician and Zeiss, and received previous research funding from Allergan, Bausch & Lomb, Shire, Tearlab. R. Dana receives funding from the National Eye Institute (R01 EY012963, R01 EY020889, R21 EY029387, UG1 EY026508-01) and the Department of Defense (VR170189), holds equity in Aramis Biosciences and Claris Biotherapeutics, and is a consultant to Dompé US, GSK, Kala, Aldeyra, and Santen. F. C. Figueiredo is a consultant and has received research grants from Chiesi Farmaceutici S.P.A. and Dompé. P. Rama received consultant fees from Chiesi Company Parma (Italy) and consultant fees and research support from Dompé Italy. The other authors have no conflicts of interest to disclose.

Funding Information:
S. X. Deng receives funding from the National Eye Institute (2R01EY021797) and California Institute for Regenerative Medicine (CLIN1-08686; CLIN2-11650) and is a consultant for F-Prime Capital, W. L. Gore & Associates, Inc, Kowa Research Institute, Inc, and Domp? US. F. Kruse is a consultant for Kowa Research Institute, Inc. C. C. Chan received honoraria previously from Alcon Labs Inc, Allergan, Bausch & Lomb, Santen, Shire, Thea, Labtician and Zeiss, and received previous research funding from Allergan, Bausch & Lomb, Shire, Tearlab. R. Dana receives funding from the National Eye Institute (R01 EY012963, R01 EY020889, R21 EY029387, UG1 EY026508-01) and the Department of Defense (VR170189), holds equity in Aramis Biosciences and Claris Biotherapeutics, and is a consultant to Domp? US, GSK, Kala, Aldeyra, and Santen. F. C. Figueiredo is a consultant and has received research grants from Chiesi Farmaceutici S.P.A. and Domp?. P. Rama received consultant fees from Chiesi Company Parma (Italy) and consultant fees and research support from Domp? Italy. The other authors have no conflicts of interest to disclose.

Funding Information:
Supported by the Cornea Society. Editorial support was provided by Julia C. Jones, PharmD, PhD, MWC, ELS, and Alis Balayan, BS.

Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc.

Keywords

Conjunctiva
Cornea
Limbal stem cell deficiency
Limbal stem cells
Stem cells
Treatment

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10.1097/ICO.0000000000002358

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@article{0ec86000501c4a0b91f35d13b990a8df,

title = "Global Consensus on the Management of Limbal Stem Cell Deficiency",

abstract = "Purpose: In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD. Methods: An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study. Results: A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo-cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established. Conclusions: This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.",

keywords = "Conjunctiva, Cornea, Limbal stem cell deficiency, Limbal stem cells, Stem cells, Treatment",

author = "\{International Limbal Stem Cell Deficiency Working Group\} and Deng, \{Sophie X.\} and Friedrich Kruse and Gomes, \{Jos{\'e} A.P.\} and Chan, \{Clara C.\} and Sheraz Daya and Reza Dana and Figueiredo, \{Francisco C.\} and Shigeru Kinoshita and Paolo Rama and Virender Sangwan and Slomovic, \{Allan R.\} and Donald Tan and Vincent Borderie and Claus Cursiefen and Ali Djalilian and Dan Epstein and Beatrice Frueh and Jesper Hjortdal and Edward Holland and Stephen Kaufman and Barry Lee and Mark Mannis and Jesus Merayo and Graziella Pellegrini and Victor Perez and Shigeto Shimmura and Alex Shortt and Avi Solomon and Ray Tsai and Scheffer Tseng and Elmer Tu",

note = "Funding Information: S. X. Deng receives funding from the National Eye Institute (2R01EY021797) and California Institute for Regenerative Medicine (CLIN1-08686; CLIN2-11650) and is a consultant for F-Prime Capital, W. L. Gore \& Associates, Inc, Kowa Research Institute, Inc, and Domp{\'e} US. F. Kruse is a consultant for Kowa Research Institute, Inc. C. C. Chan received honoraria previously from Alcon Labs Inc, Allergan, Bausch \& Lomb, Santen, Shire, Thea, Labtician and Zeiss, and received previous research funding from Allergan, Bausch \& Lomb, Shire, Tearlab. R. Dana receives funding from the National Eye Institute (R01 EY012963, R01 EY020889, R21 EY029387, UG1 EY026508-01) and the Department of Defense (VR170189), holds equity in Aramis Biosciences and Claris Biotherapeutics, and is a consultant to Domp{\'e} US, GSK, Kala, Aldeyra, and Santen. F. C. Figueiredo is a consultant and has received research grants from Chiesi Farmaceutici S.P.A. and Domp{\'e}. P. Rama received consultant fees from Chiesi Company Parma (Italy) and consultant fees and research support from Domp{\'e} Italy. The other authors have no conflicts of interest to disclose. Funding Information: S. X. Deng receives funding from the National Eye Institute (2R01EY021797) and California Institute for Regenerative Medicine (CLIN1-08686; CLIN2-11650) and is a consultant for F-Prime Capital, W. L. Gore \& Associates, Inc, Kowa Research Institute, Inc, and Domp? US. F. Kruse is a consultant for Kowa Research Institute, Inc. C. C. Chan received honoraria previously from Alcon Labs Inc, Allergan, Bausch \& Lomb, Santen, Shire, Thea, Labtician and Zeiss, and received previous research funding from Allergan, Bausch \& Lomb, Shire, Tearlab. R. Dana receives funding from the National Eye Institute (R01 EY012963, R01 EY020889, R21 EY029387, UG1 EY026508-01) and the Department of Defense (VR170189), holds equity in Aramis Biosciences and Claris Biotherapeutics, and is a consultant to Domp? US, GSK, Kala, Aldeyra, and Santen. F. C. Figueiredo is a consultant and has received research grants from Chiesi Farmaceutici S.P.A. and Domp?. P. Rama received consultant fees from Chiesi Company Parma (Italy) and consultant fees and research support from Domp? Italy. The other authors have no conflicts of interest to disclose. Funding Information: Supported by the Cornea Society. Editorial support was provided by Julia C. Jones, PharmD, PhD, MWC, ELS, and Alis Balayan, BS. Publisher Copyright: Copyright {\textcopyright} 2020 Wolters Kluwer Health, Inc.",

year = "2020",

doi = "10.1097/ICO.0000000000002358",

language = "English (US)",

volume = "39",

pages = "1291--1302",

journal = "Cornea",

issn = "0277-3740",

publisher = "Lippincott Williams and Wilkins",

number = "10",

}

TY - JOUR

T1 - Global Consensus on the Management of Limbal Stem Cell Deficiency

AU - International Limbal Stem Cell Deficiency Working Group

AU - Deng, Sophie X.

AU - Kruse, Friedrich

AU - Gomes, José A.P.

AU - Chan, Clara C.

AU - Daya, Sheraz

AU - Dana, Reza

AU - Figueiredo, Francisco C.

AU - Kinoshita, Shigeru

AU - Rama, Paolo

AU - Sangwan, Virender

AU - Slomovic, Allan R.

AU - Tan, Donald

AU - Borderie, Vincent

AU - Cursiefen, Claus

AU - Djalilian, Ali

AU - Epstein, Dan

AU - Frueh, Beatrice

AU - Hjortdal, Jesper

AU - Holland, Edward

AU - Kaufman, Stephen

AU - Lee, Barry

AU - Mannis, Mark

AU - Merayo, Jesus

AU - Pellegrini, Graziella

AU - Perez, Victor

AU - Shimmura, Shigeto

AU - Shortt, Alex

AU - Solomon, Avi

AU - Tsai, Ray

AU - Tseng, Scheffer

AU - Tu, Elmer

N1 - Funding Information: S. X. Deng receives funding from the National Eye Institute (2R01EY021797) and California Institute for Regenerative Medicine (CLIN1-08686; CLIN2-11650) and is a consultant for F-Prime Capital, W. L. Gore & Associates, Inc, Kowa Research Institute, Inc, and Dompé US. F. Kruse is a consultant for Kowa Research Institute, Inc. C. C. Chan received honoraria previously from Alcon Labs Inc, Allergan, Bausch & Lomb, Santen, Shire, Thea, Labtician and Zeiss, and received previous research funding from Allergan, Bausch & Lomb, Shire, Tearlab. R. Dana receives funding from the National Eye Institute (R01 EY012963, R01 EY020889, R21 EY029387, UG1 EY026508-01) and the Department of Defense (VR170189), holds equity in Aramis Biosciences and Claris Biotherapeutics, and is a consultant to Dompé US, GSK, Kala, Aldeyra, and Santen. F. C. Figueiredo is a consultant and has received research grants from Chiesi Farmaceutici S.P.A. and Dompé. P. Rama received consultant fees from Chiesi Company Parma (Italy) and consultant fees and research support from Dompé Italy. The other authors have no conflicts of interest to disclose. Funding Information: S. X. Deng receives funding from the National Eye Institute (2R01EY021797) and California Institute for Regenerative Medicine (CLIN1-08686; CLIN2-11650) and is a consultant for F-Prime Capital, W. L. Gore & Associates, Inc, Kowa Research Institute, Inc, and Domp? US. F. Kruse is a consultant for Kowa Research Institute, Inc. C. C. Chan received honoraria previously from Alcon Labs Inc, Allergan, Bausch & Lomb, Santen, Shire, Thea, Labtician and Zeiss, and received previous research funding from Allergan, Bausch & Lomb, Shire, Tearlab. R. Dana receives funding from the National Eye Institute (R01 EY012963, R01 EY020889, R21 EY029387, UG1 EY026508-01) and the Department of Defense (VR170189), holds equity in Aramis Biosciences and Claris Biotherapeutics, and is a consultant to Domp? US, GSK, Kala, Aldeyra, and Santen. F. C. Figueiredo is a consultant and has received research grants from Chiesi Farmaceutici S.P.A. and Domp?. P. Rama received consultant fees from Chiesi Company Parma (Italy) and consultant fees and research support from Domp? Italy. The other authors have no conflicts of interest to disclose. Funding Information: Supported by the Cornea Society. Editorial support was provided by Julia C. Jones, PharmD, PhD, MWC, ELS, and Alis Balayan, BS. Publisher Copyright: Copyright © 2020 Wolters Kluwer Health, Inc.

PY - 2020

Y1 - 2020

N2 - Purpose: In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD. Methods: An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study. Results: A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo-cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established. Conclusions: This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.

AB - Purpose: In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD. Methods: An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study. Results: A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo-cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established. Conclusions: This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.

KW - Conjunctiva

KW - Cornea

KW - Limbal stem cell deficiency

KW - Limbal stem cells

KW - Stem cells

KW - Treatment

UR - https://www.scopus.com/pages/publications/85090510767

UR - https://www.scopus.com/pages/publications/85090510767#tab=citedBy

U2 - 10.1097/ICO.0000000000002358

DO - 10.1097/ICO.0000000000002358

M3 - Article

C2 - 32639314

AN - SCOPUS:85090510767

SN - 0277-3740

VL - 39

SP - 1291

EP - 1302

JO - Cornea

JF - Cornea

IS - 10

ER -

Global Consensus on the Management of Limbal Stem Cell Deficiency

Abstract

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