Systematic review and meta-analysis investigating autograft versus allograft in cultivated limbal epithelial transplantation in limbal stem cell deficiency

Purpose: Currently, regenerative medicine has attracted much attention among researchers investigating new methods to treat ocular surface diseases. Based on this new concept, cultivated limbal epithelial transplantation (CLET) has emerged as a promising surgical procedure for treating limbal stem cell deficiency (LSCD). The present review and meta-analysis aimed to compare and determine the efficacy of two different CLET techniques, autologous versus allogeneic, based on a literature review of relevant studies.Methods: A comprehensive search of electronic databases, including PubMed, Google Scholar, and SCOPUS, for related articles was performed in November 2017 to obtain relevant articles to conduct a meta-analysis investigating the success rate of ocular surface regeneration and two-line improvement in visual acuity using autograft and allograft cases.Results: A total of 33 studies, including 1308 eyes from 1304 patients with LSCD, with a sample size ranging from 3 to 166, and follow-up period of 20 days to 121 months, were reviewed. Of 1308 eyes, 1143 (87.38%) underwent autograft and 165 (12.62%) received allografts from living or deceased donors. Meta-analysis revealed that the success rate and two-line visual acuity improvement using autografts were 1.93 and 1.2 times higher than allografts, respectively (pooled OR 1.93 [95% CI 0.91 to 4.13]; pooled OR 1.2 [95% CI 0.59 to 2.45]); however, the difference was not statistically significant.Conclusion: Although CLET is a useful therapeutic modality for the treatment of LSCD, the present analysis revealed no significant differences in success rates or visual improvement between autograft and allograft surgical techniques.