Stem cell–based therapy for corneal epithelial reconstruction: present and future

Abstract Limbal stem cell deficiency is a painful and potentially blinding disease. Cultured limbal epithelial transplantation (CLET) is frequently performed for corneal surface reconstruction with variable clinical success. This work summarizes recent developments and trends that have the potential to increase safety and efficacy of CLET in the future. Apart from gradual transition to xenobiotic-free culture systems, novel biofunctional scaffolds presenting components of stem cell microenvironments aim at promoting long-term maintenance of stem cells in vitro and after transplantation. Hair follicles and other tissues may serve as autologous sources of adult stem cells in bilateral ocular surface disease. However, despite all progress made in the fields of tissue engineering and cell therapy, it is unlikely that CLET will yield fully satisfactory clinical results until the factors that govern limbal stem cell maintenance and differentiation are identified.