A Comprehensive Systematic Review and Evidence-Based Framework for Evaluating Limbal Stem Cell Transplantation in Ocular Surface Reconstruction and Corneal Transparency Restoration
Abstract
: Limbal stem cell transplantation (LSCT) has emerged as a transformative therapeutic strategy for ocular surface reconstruction in patients with limbal stem cell deficiency (LSCD), a condition that leads to chronic epithelial instability, corneal opacity, and severe visual impairment. Despite significant advancements in surgical techniques such as simple limbal epithelial transplantation (SLET), cultivated limbal epithelial transplantation (CLET), keratolimbal allografts, and amniotic membrane-assisted procedures, clinical outcomes remain heterogeneous due to variations in patient selection, surgical protocols, and postoperative management strategies. This systematic review synthesizes current clinical evidence to evaluate the effectiveness of LSCT in restoring corneal clarity and ocular surface integrity while proposing an integrated evidence-based analytical framework for outcome assessment.
Findings from randomized controlled trials and clinical comparative studies indicate that autologous and allogeneic limbal stem cell approaches significantly improve epithelial regeneration and visual rehabilitation, though success rates are influenced by disease severity, underlying etiology, and adjunctive therapies (Sharma et al., 2024). Comparative evidence further demonstrates variability between SLET and CLET approaches in ocular burn populations, highlighting the need for standardized evaluation metrics (Arora et al., 2017). The review identifies key gaps in long-term outcome consistency, immunological management, and objective imaging-based assessment tools.
An evidence-based framework is proposed integrating clinical grading scales, optical coherence tomography (OCT) biomarkers, and functional visual outcomes to standardize LSCT evaluation. This framework aims to enhance reproducibility, optimize patient stratification, and guide future translational research in corneal regenerative medicine.
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