Simple Limbal Epithelial Transplantation Restores Corneal Surface

Dendritic Herpes Simplex Virus Infection Of The Corneal Epithelium. (Photo By BSIP/UIG Via Getty Images)
The study shows visual improvements following 2 types of corneal surgeries.

Simple limbal epithelial transplantation (SLET), an alternative to limbal stem cell transplantation, is a cost-effective and safe option for regenerating and restoring the corneal surface, according to research published in The Ocular Surface.

 The procedure can “substantially restore” the vision of patients with limbal stem cell deficiency-induced corneal blindness.

Severe ocular surface diseases, chemical injuries, Stevens-Johnson syndrome, and extensive keratitis can cause chronic ocular inflammation, producing limbal stem cell deficiency (LSCD). Limbal stem cell transplantation (LSCT) has been the primary procedure for managing LSCD during the past few decades. However, the popularity and efficacy of the procedure has been limited by surgical technique and laboratory support, according to the researchers.

SLET is a new LSCT technique designed to simplify the treatment of LSCD and other conditions.

Researchers conducted a prospective multicenter study to evaluate the efficacy and outcome of SLET for limbal stem cell deficiency. The study included patients with LSCD who underwent autologous SLET (autoSLET) and living-related allogenic SLET (Lr-alloSLET). All patients were assessed by slit-lamp biomicroscopy, in vivo confocal microscopy (IVCM), and impression cytology with immunofluorescence staining (ICIF) before and after surgery. Visual improvement and risk factors for SLET failure were analyzed.

A total of 28 eyes of 26 patients (11 autoSLET and 17 Lr-alloSLET) were included in the study. The median age was 53 years (range, 35 to 63 years), and the follow-up time was 29.5 months (range, 17.5 to 39.8 months). The overall survival rate was 89.3% at 2 years and 75.6% at 3 years with no difference between autoSLET and Lr-alloSLET (P =.24). During the study, 7 eyes subsequently underwent penetrating keratoplasty

Immunohistochemistry analysis showed that all corneal buttons had corneal epithelium and limbal stem cell markers. Visual improvement was achieved in both SLET groups (P <.001). Failed SLET developed between 5 and 32 months postoperatively. However, absolute risk factors for SLET failure were not noted.

Researchers conclude that the efficacy of autoSLET and Lr-alloSLET for LSCD is excellent and that “The transplanted limbal stem cells of SLET can effectively revive and sustain the corneal surface,”

The limitations of this study include its small sample size and a lack of quantification of each ICIF marker being analyzed. 

Reference

Prabhasawat P, Chirapapaisan C, Ngowyutagon P, et al. Efficacy and outcome of simple limbal epithelial transplantation for limbal stem cell deficiency verified by epithelial phenotypes integrated with clinical evaluation. Ocul Surf. 2021:22(10):27-37., doi:10.1016/j.jtos.2021.06.012