Abstract

SA.05.10

Therapeutic strategies in limbal stem cell dysfunction

Reinhard T. 
Universitäts-Augenklinik Freiburg

Some years ago a variety of corneal and conjunctival diseases was classified on the basis of the limbal stem cell concept. Two groups of limbal stem cell diseases are known: 1. Diseases with a lack of limbal stem cells (e.g. sclerocornea, congenital aniridia, chemical burns, immunological diseases); 2. Diseases with limbal stem cell dysfunction (e.g. epithelial corneal dystrophies, Salzmann nodules, pterygium).
Patients with partial or total unilateral lack of stem cells may be treated with autologous lamellar stem cell grafts or transplantation of stem cells following ex vivo expansion on amnion or alternative layers. For these procedures the stem cells are harvested in the contralateral eye. In bilateral disease homologous limbal stem cell transplantation with or without penetrating keratoplasty may be performed.
Depending on the cause for limbal stem cell dysfunction various therapeutical procedures may be performed, e.g. PTK in epithelial basement membrane dystrophy, ablation of Salzmann nodules, excision and transplantation of autologous conjunctiva in pterygium. For many patients with stem cell dysfunction only stem cell transplantation should be curative. Regarding that procedure in limbal stem cell dysfunction, however, the only experience concerns granular and lattice dystrophy.

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