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Sayan Basu, Shraddha Surekha, Vivek Singh, Virender S Sangwan; Simple Limbal Epithelial Transplantation (SLET) for Long-term Corneal Surface Regeneration in Unilateral Ocular Burns. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2072.
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Severe ocular burns can destroy the corneal epithelial stem cells at the limbus resulting in a blinding disease called limbal stem cell deficiency (LSCD). This study describes the long-term outcomes of a relatively new technique of treating LSCD called Simple Limbal Epithelial Transplantation (SLET).
This retrospective case series included 125 eyes of 60 children and 65 adults who underwent SLET for treatment of unilateral total (n=107) or focal (n=18) LSCD between 2010 and 2013. The surgical technique of SLET involved obtaining a one-clock-hour sized limbal biopsy from the healthy eye, dividing it into smaller pieces and then transplanting them directly onto the affected eye over a human amniotic membrane graft. The primary outcome measure was the rate of successful transplantation, defined clinically and by using high-resolution optical coherence tomography imaging, as a completely epithelized and avascular corneal surface. Secondary outcome measures were improvement in best-corrected visual acuity (BCVA), incidence of complications and immunohistochemical analysis of the transplanted epithelium.
The median post-operative follow-up was 1.5 years (range: 1 to 4 years). Kaplan-Meier survival analysis showed an overall success rate of 76% at 1-year and beyond. Successful transplantation was maintained until final follow-up in 72% of children and 80% of adults; and in 75% and 83% of cases of total and focal LSCD, respectively. Multivariate analysis revealed that presence of symblepharon (P<0.0001, OR=11.6), combining SLET with keratoplasty (P=0.007, OR=8.1) and evidence of calcification on histopathology (P=0.003, OR=4.7) were significant high-risk factors of SLET failure. BCVA improved from 20/200 or worse in all eyes to 20/60 or better in 60% of successful cases. No adverse effects were noted in the donor fellow eyes. Immunohistochemistry of post-SLET corneas excised during keratoplasty showed presence of uniform stratified squamous epithelium expressing cornea-specific markers (CK3/12) and absence of conjunctival marker (Muc5AC).
Autologous SLET effectively restores the normal corneal surface and improves vision in cases with blinding unilateral corneal burns. SLET is also a safe and affordable alternative to existing techniques of limbal stem cell therapy for corneal burns as it requires minimal donor tissue without laboratory cultivation,
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