Update on the Surgical Reconstruction of Ocular Surface in Eyes with Limbal Stem Cell Deficiency

Purpose of Review: To determine indications, advantages, disadvantages, and potential complications of current surgical approaches for reconstruction of ocular surface in subjects with limbal stem cell deficiency (LSCD). Recent Findings: Recently, autologous limbal stem cell transplant (LSCT) has demonstrated to have positive clinical outcomes for visual rehabilitation. Simple limbal epithelial transplantation (SLET) in subjects with unilateral LSCD and wet ocular surface is a clear example of this. Keratoprosthetic devices and their late modifications remain the best option for subjects with bilateral LSCD and a wet ocular surface. Modified Osteo-Odonto KPro (MOOKP) continues to be the best option for patients with LSCD and a keratinized ocular surface. Potential sources of stem cells are being elucidated, predominantly, mesenchymal stem cells (MSCs) with encouraging results in terms of tissue regeneration along with new cell carriers. Summary: Determining which surgery should be performed is individual to each case; however, it is imperative to control acute inflammation prior to surgery in all cases and even suppress inflammation postoperatively for successful long-term outcomes. Only long-term follow-up of novel therapies will allow to establish their effectiveness. Ideal novel surgeries must aim for long-lasting corneal transparency with high reproducibility and low cost to be available worldwide.