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D. Balasubramanian, K. Sejpal, S. Krishnaiah, G. K. Vemuganti, V. S. Sangwan, S. Gaddipati, S. Tiwari; Clinical Outcome of Ex Vivo Cultivated, Autologous Limbal Epithelial Transplantation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3750.
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To evaluate the results of autologous, ex vivo cultivated limbal epithelial transplantation (CLET) for limbal stem cell deficiency (LSCD)
This is a retrospective, noncomparative, interventional case series. Case records of patients undergoing CLET were reviewed for demographics, etiology, outcome and complications. Stability of the ocular surface and improvement in visual acuity were the primary and secondary outcomes, respectively.
CLET was performed in 477 eyes between April 2001 and March 2009, of which of 404 eyes of 395 patients with >6 weeks follow-up were included. Mean age was 21 years (range 2 to 69 years). Chemical injury was the predominant etiology in 85.64% eyes. 299 eyes had total LSCD. At a mean follow-up duration of 21 months, ocular surface stability could be achieved in 242 eyes (59.9%) (complete success: 198 eyes, 49%; 95 %Confidence interval CI: 44.1 to 53.9, partial success: 44 eyes, 10.9%; 95% CI : 7.9 TO 13.9). Repeat CLET was performed in 72 eyes (17.8%), of which 27 eyes (37.5%) were successful. Penetrating keratoplasty was performed in 51 eyes (12.62%) and lamellar keratoplasty in 4 eyes (0.99%) for visual rehabilitation. The mean LogMar preoperative visual acuity was 1.54+0.61 and the postoperative visual acuity at 6 months, 12 months and 2 years was 1.25+0.71, 1.17+0.72 and 1.09+0.77 respectively. Postoperatively, there was a statistically significant improvement in vision at each follow-up (p<0.001). The visual acuity was ≥6/60 in 44.8% of the total eyes at the final follow-up. Amblyopia limited visual improvement in pediatric patients. Complications were noted in 81 eyes (20%), the most common being rise in intraocular pressure, graft rejection and microbial keratitis.
CLET is seen to be a viable treatment option, with good outcome. Repeat surgery may be required to stabilize the ocular surface.
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