Why Are Corneal Specialists Resistant to Treating Patients Who Have Severe Ocular Surface Disease With Limbal Stem Cell Deficiency?
Journal
Cornea
ISSN: 1536-4798
Titre abrégé: Cornea
Pays: United States
ID NLM: 8216186
Informations de publication
Date de publication:
01 Sep 2023
01 Sep 2023
Historique:
received:
27
10
2022
accepted:
05
05
2023
medline:
7
8
2023
pubmed:
3
8
2023
entrez:
3
8
2023
Statut:
ppublish
Résumé
To highlight the paucity of surgeons performing ocular surface stem cell transplantation with systemic immunosuppression (OSSTx with SI) for limbal stem cell deficiency (LSCD) patients, suboptimal treatments for LSCD, and obstacles to adoption. A review of the Eye Bank Association of America annual reports and the authors' case volume for OSSTx with SI was performed. Examination of the published literature on corneal surgeries, especially for LSCD, was completed. These findings were combined with our clinical observations to develop this editorial. Despite techniques and protocols for OSSTx with SI published more than 30 years ago for the treatment of severe bilateral LSCD, only a small number of corneal specialists have adopted these techniques. There is a paucity of attention to this population of patients, with minimal publications to advance this area of our field. We are too often referred patients with LSCD and severe ocular surface disease that have had suboptimal treatments such as penetrating keratoplasties or primary keratoprostheses. Hesitancy for adopting OSSTx with SI is likely due to a lack of exposure to these procedures during training and fear of systemic immunosuppression. Corneal surgeons are likely unaware of the safety of systemic immunosuppression with appropriate monitoring especially when comanaging these patients with an organ transplant specialist. There is a large unmet need for the treatment of corneal blindness secondary to conjunctival and LSCD. For the vast majority of patients, OSSTx should be the first surgical choice to treat these eyes. We hope major ophthalmology centers will meet this need by building programs, and groups of corneal surgeons should collaborate to create regional centers to make this treatment more accessible to help this population.
Identifiants
pubmed: 37535943
doi: 10.1097/ICO.0000000000003322
pii: 00003226-202309000-00001
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1063-1068Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
There were no relevant financial conflicts of interest regarding this work. EJH has consulted for Alcon Laboratories, Aurion Biotech, Avellino Corp, and Orasis. AYC has consulted for Sight Sciences and LayerBio. ARD has consulted for Novartis and Kala Therapeutics. MF has consulted for Aldeyra; Johnson & Johnson Vision; Bausch & Lomb GmbH; Allergan, Inc.; Dompe; Novartis AG; CorneaGen; Bio-Tissue, Inc.; Kala Pharmaceuticals, Inc.; Carl Zeiss Meditec AG; Sun Pharmaceutical; Tarsus; and Orasis. MJM does not have any financial disclosures. There was no funding received for this study.
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