Twenty-six noncomparative case series were included (n=687 patients and 738 eyes).
Most studies evaluated a representative sample, assessed objective outcome measures and clearly reported main findings. Flaws included non-consecutive selection, follow-up less than three years, patients entered at different stages of disease, retrospective data collection, failure to identify all prognostic factors and no information about drop-outs.
Bilateral severe or total limbal stem cell deficiency: The most common surgical procedure was keratolimbal allograft plus systematic immunosuppression. An improvement on BCVA of two lines or more was reported in 31 per cent to 67 per cent of eyes (three studies). A reduction in VA from baseline was reported in zero to 18 per cent of patients. Other adverse events included postoperative glaucoma (26 per cent to 32 per cent across three studies), microbial keratitis (eight per cent to 14 per cent across two studies) and corneal necrosis (14 per cent in one study).
Unilateral severe total limbal stem cell deficiency: The most common surgical procedure was contralateral conjunctival limbal autograft. An improvement on BCVA of two lines or more was reported in 35 per cent to 88 per cent of eyes (five or eight studies, the number of studies providing data was not entirely clear). Adverse events in patients who had undergone CLAU procedures (with or without other procedures) included a reduction in VA from baseline in zero to four per cent of patients and postoperative glaucoma in zero to nine per cent. For patients who had undergone KLAL, a reduction in VA from baseline was reported in zero to nine per cent and glaucoma in 19 to 37 per cent.
Partial limbal stem cell deficiency: The only study in patients with partial LSCD evaluated AMT and reported an improvement on BCVA of two lines or more in 59 per cent of patients (10/17; reported as 39 per cent in the abstract). One patient (six per cent) had a reduction in VA and one had an immune rejection episode.
Results for other studies were also reported.