The limbus is a narrow band of tissue that encircles the cornea, the transparent 'window' into the eye. The outermost layer of the cornea is the epithelium, which is necessary for clear vision. The limbus acts as a 'reservoir' for limbal stem cells which maintain and regenerate the corneal epithelium. It also functions as a barrier to the conjunctiva and its blood vessels. Limbal stem cell deficiency is a general term for diseases which are characterised by the impairment of the limbus, limbal stem cells and their ability to replenish the corneal epithelium through proliferation and differentiation. Consequently, sufferers experience chronic pain and progressive blindness. This paper will highlight the salient milestones of limbal stem cell biology and potential future treatments for limbal stem cell deficiency.

The cornea is the clear front of the eye and its surface is composed of an epithelium. This is renewed by stem cells located at the limbus, which encircles the periphery of the cornea. These limbal stem cells become lost or deficient in the blinding disease of limbal stem cell deficiency. In this review article, we discuss the historical perspective in managing limbal stem cell deficiency as well as describing the more contemporary treatment options, and in particular the culture and transplantation of human limbal stem cells. This treatment was first proposed 13 years ago and many case series have been presented to date showing promising outcomes of this technique. However, challenges still remain in treating the debilitating disease of limbal stem cell deficiency. Here we discuss some of the questions, which remain to be answered in this field.

Limbal-derived MSC exhibited plasticity, could maintain limbal markers expression and demonstrated viable growth on amniotic membrane.

The cornea at the front of the eye is covered by an epithelium. This epithelium is maintained by stem cells located at the periphery of the cornea, in a region known as the limbus. Because this region harbors the stem cells for the corneal epithelium, the so-called limbal stem cells, its culture provides considerable interest. Limbal epithelial culture is used for two main reasons. The first is to further our understanding of limbal stem-cell biology. The second is for the culture expansion of limbal stem cells for transplantation purposes in patients with limbal stem-cell deficiency. However, considerable variations in the culture methods for limbal epithelium exist. These include culture media, sera used in the culture, use of 3T3 fibroblasts or amniotic membrane or both, the culture of whole pieces of limbal tissue or enzymatically digested tissue, and the use of airlifting.