Autologous simple limbal stem cell transplantation: a case series
DOI:
https://doi.org/10.12809/hkjo-v26n2-317Keywords:
Corneal injuries, Limbus Corneae, Stem cell transplantationAbstract
This case series reviewed medical records of eight patients who underwent autologous simple limbal epithelial transplantation (SLET) for total limbal stem cell deficiency (LSCD) secondary to chemical injury (n=5), thermal injury (n=2), or autoimmune disorder (n=1) between 2016 to 2019 at the Caritas Medical Centre. The mean time from injury to SLET was 67 months (range, 3 weeks to 30 years). The mean time to re-epithelialization was 20 (range, 13-42) days. The follow-up duration ranged from 1 to 6 years. At the 1-year follow-up, the success rate of SLET was 37.5%, and visual gain among the three successful cases ranged from <1 line to >6 lines. Patients with Dua grade V or VI chemical injury and patients with systemic causes of LSCD had poorer prognosis, as did those with cicatricial lid changes, anterior segment necrosis, glaucoma, sterile cornea ulceration, superimposed infections, or tobacco usage. SLET should be a reconstructive procedure for chronic LSCD rather than for acute injury or inflammation.
References
Jhagta HS, Jain P. Limbal stem cell deficiency: a review. J Clin Ophthalmol Res 2015;3:71-5. DOI: https://doi.org/10.4103/2320-3897.156582
Singh P, Tyagi M, Kumar Y, Gupta KK, Sharma PD. Ocular chemical injuries and their management. Oman J Ophthalmol 2013;6:83-6. DOI: https://doi.org/10.4103/0974-620X.116624
Sekhon A, Wang JYF, Tan JCH, Holland SP, Yeung SN. Limbal stem cell deficiency secondary to systemic paclitaxel (Taxol) for breast cancer: a case report. BMC Ophthalmol 2020;20:400. DOI: https://doi.org/10.1186/s12886-020-01672-x
Mehta U, Farid M. Dupilumab induced limbal stem cell deficiency. Int Med Case Rep J 2021;14:275-8. DOI: https://doi.org/10.2147/IMCRJ.S308583
Deng SX, Kruse F, Gomes JAP, et al. Global consensus on the management of limbal stem cell deficiency. Cornea 2020;39:1291-302. DOI: https://doi.org/10.1097/ICO.0000000000002358
Shanbhag SS, Nikpoor N, Rao Donthineni P, Singh V, Chodosh J, Basu S. Autologous limbal stem cell transplantation: a systematic review of clinical outcomes with different surgical techniques. Br J Ophthalmol 2020;104:247-53. DOI: https://doi.org/10.1136/bjophthalmol-2019-314081
Gupta N, Joshi J, Farooqui JH, Mathur U. Results of simple limbal epithelial transplantation in unilateral ocular surface burn. Indian J Ophthalmol 2018;66:45-52. DOI: https://doi.org/10.4103/ijo.IJO_602_17
Le Q, Chauhan T, Yung M, Tseng CH, Deng SX. Outcomes of limbal stem cell transplant: a meta-analysis. JAMA Ophthalmol 2020;138:660-70. DOI: https://doi.org/10.1001/jamaophthalmol.2020.1120
Vazirani J, Ali MH, Sharma N, et al. Autologous simple limbal epithelial transplantation for unilateral limbal stem cell deficiency: multicentre results. Br J Ophthalmol 2016;100:1416-20. DOI: https://doi.org/10.1136/bjophthalmol-2015-307348
Basu S, Sureka SP, Shanbhag SS, Kethiri AR, Singh V, Sangwan VS. Simple limbal epithelial transplantation: long-term clinical outcomes in 125 cases of unilateral chronic ocular surface burns. Ophthalmology 2016;123:1000-10. DOI: https://doi.org/10.1016/j.ophtha.2015.12.042
Shanbhag SS, Patel CN, Goyal R, Donthineni PR, Singh V, Basu S. Simple limbal epithelial transplantation (SLET): review of indications, surgical technique, mechanism, outcomes, limitations, and impact. Indian J Ophthalmol 2019;67:1265-77. DOI: https://doi.org/10.4103/ijo.IJO_117_19
Soleimani M, Naderan M. Management strategies of ocular chemical burns: current perspectives. Clin Ophthalmol 2020;14:2687-99. DOI: https://doi.org/10.2147/OPTH.S235873
Dua HS, Miri A, Faraj LA, Said DG. Free autologous conjunctival grafts. Ophthalmology 2012;119:2189-2189.e2. DOI: https://doi.org/10.1016/j.ophtha.2012.06.004
Deng SX, Borderie V, Chan CC, et al. Global consensus on definition, classification, diagnosis, and staging of limbal stem cell deficiency. Cornea 2019;38:364-75. DOI: https://doi.org/10.1097/ICO.0000000000001820
Le Q, Chauhan T, Deng SX. Diagnostic criteria for limbal stem cell deficiency before surgical intervention: a systematic literature review and analysis. Surv Ophthalmol 2020;65:32-40. DOI: https://doi.org/10.1016/j.survophthal.2019.06.008
Dua HS, Miri A, Said DG. Contemporary limbal stem cell transplantation: a review. Clin Exp Ophthalmol 2010;38:104-17. DOI: https://doi.org/10.1111/j.1442-9071.2010.02229.x
Kuckelkorn R, Schrage N, Reim M. Treatment of severe eye burns by tenonplasty. Lancet 1995;345:657-8. DOI: https://doi.org/10.1016/S0140-6736(95)90564-2
Iyer G, Srinivasan B, Agarwal S, Tarigopula A. Outcome of allo simple limbal epithelial transplantation (alloSLET) in the early stage of ocular chemical injury. Br J Ophthalmol 2017;101:828-33. DOI: https://doi.org/10.1136/bjophthalmol-2016-309045
Dhillon HK, Bahadur H, Raj A. A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects. Indian J Ophthalmol 2020;68:29-33. DOI: https://doi.org/10.4103/ijo.IJO_617_19
Jain R, Kanaujia V, Sahu S, Das S. Management of unilateral limbal stem cell deficiency by simple limbal epithelial transplantation: our experience. MOJ Surg 2014;1:4-7. DOI: https://doi.org/10.15406/mojs.2014.01.00002
Mittal V, Jain R, Mittal R, Vashist U, Narang P. Successful management of severe unilateral chemical burns in children using simple limbal epithelial transplantation (SLET). Br J Ophthalmol 2016;100:1102-8. DOI: https://doi.org/10.1136/bjophthalmol-2015-307179
Amescua G, Atallah M, Nikpoor N, Galor A, Perez VL. Modified simple limbal epithelial transplantation using cryopreserved amniotic membrane for unilateral limbal stem cell deficiency. Am J Ophthalmol 2014;158:469-75.e2. DOI: https://doi.org/10.1016/j.ajo.2014.06.002
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Hong Kong Journal of Ophthalmology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Journal has a fully Open Access policy and publishes all articles under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. For any use other than that permitted by this license, written permission must be obtained from the Journal.
