Autologous limbal stem cell transplantation (LSCT) may be a better choice than the allogenic form, as the former procedure showed greater restoration of the ocular surface and lower complication rates, a study in JAMA Ophthalmology suggests.

The meta-analysis included 40 studies and 2,202 eyes that underwent one of four different transplant procedures. Outcome measures included ocular surface improvements, visual acuity (VA) and any adverse events of recipient and donor eyes.

The average age of participants was 38, and 74% of the study subjects were male. A total of 505 subjects underwent direct autologous LSCT, 742 had direct allogenic LSCT, 771 had cultivated autologous LSCT and 184 underwent cultivated allogenic LSCT.

The researchers reported 74.5% of all study eyes achieved ocular surface improvements, including 85.7% in direct autologous patients, 84.7% in the cultivated autologous group, 57.8% in direct allogenic participants and 63.2% in the cultivated allogenic group.

Direct autologous limbal transplantation also had the best VA improvement rate at 76% compared with the other three procedures (cultivated autologous, 56.4%; direct allogenic, 52.3%; cultivated allogenic, 43.3%).

The most common adverse events in all recipient eyes were recurrent/persistent epithelial erosion (10.5%) and elevated intraocular pressure (1.7%). Patients who underwent direct allogenic LSCT had the highest rate of recurrent epithelial erosion (27.8%) and intraocular pressure elevation (6.3%).

While autologous transplant procedures appeared to have more favorable outcomes, disease grading and other efficacy outcome measures varied greatly among the different studies. As such, randomized trials with standardized measures are necessary to better determine whether one approach is more effective than the other, the investigators noted.