COMMENTARY

New Simple Limbal Epithelial Transplantation Method Promising in Ocular Burns

Christopher J. Rapuano, MD

Disclosures

July 21, 2016

Simple Limbal Epithelial Transplantation: Long-Term Clinical Outcomes in 125 Cases of Unilateral Chronic Ocular Surface Burns

Basu S, Sureka SP, Shanbhag SS, Kethiri AR, Singh V, Sangwan VS
Ophthalmology. 2016;123:1000-1010

Study Summary

The authors behind this case series describe relatively long-term results of simple limbal epithelial transplantation (SLET), a procedure they pioneered for patients with unilateral limbal stem cell deficiency (LSCD). Between 2010 and 2014, 125 patients (65 adults and 60 children) with chemical or thermal burns to one eye causing total or near-total LSCD, and a normal fellow eye, were included.

The procedure involved taking a 1–clock-hour limbal biopsy sample from the unaffected eye, and dividing it into approximately a dozen small pieces that were then placed on the de-epithelialized recipient cornea on a bed of amniotic membrane tissue. The pieces were held in place with fibrin glue, with a bandage soft contact lens placed on the eye.

The authors defined success as complete re-epithelialization with a stable avascular corneal surface. Failure was defined as conjunctivalization of the cornea encroaching within the central 8 mm, persistent epithelial defect, microbial keratitis, or need for repeat SLET.

After a mean follow-up of 1.5 years (range, 1-4 years), success was achieved in 76% of eyes. Survival analysis demonstrated similarly successful results at 1 year in both adults (80%) and children (72%). Improvements of two or more Snellen lines were achieved in 75% of eyes, and 67% of successful cases achieved 20/60 or better vision. Similar results were observed among faculty and trainees.

Clinical failure was associated with acid injury, severe symblepharon, SLET combined with keratoplasty, and postoperative loss of SLET transplants. None of the donor eyes developed evidence of donor-site LSCD or other complications.

The authors concluded that SLET is an effective, reliable, and replicable technique for long-lasting regeneration and vision restoration in unilateral ocular surface burns.

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