AimsTo report the global uptake of simple limbal epithelial transplantation (SLET) and compare the economic, clinical and social outcomes of SLET with those of cultured limbal epithelial transplantation (CLET).MethodsA comprehensive literature review and an online survey of eye surgeons were conducted to understand the efficacy and current uptake of SLET surgery. A de novo economic model was developed to estimate the cost savings with SLET compared with CLET. Our economic analysis is conducted from an Indian perspective, as this is where the technique originated. A scenario analysis using the UK cost data and a user-friendly Excel model is included to allow users to input the costs from their setting to estimate the cost savings with using SLET compared with using CLETResultsThe anatomical success with SLET in adults (72.6% (range 62%–80%)) was the same as CLET (70.4% (range 68%–80.9%)). For children, the outcome for SLET (77.8% (range 73%–83%)) was better than with CLET (44.5% (range 43%–45%)). In response to our informal questionnaire, 99 surgeons reported to have performed SLET on 1174 patients in total. They appreciated that SLET negates the requirement for costly tissue engineering facilities. Results of economic analysis suggested that SLET provided an estimated cost-savings of US$6470.88 for adults and US$6673.10 for children. In broad terms, the cost of SLET is approximately 10% of the cost of CLET for adults and 8% for children.ConclusionSLET offers a more accessible and financially attractive alternative to CLET to treat limbal stem cell deficiency.

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1,2 This procedure has been associated with excessive mortality rates, persistent right heart failure, intra-alveolar and interstitial pulmonary edema, and massive parenchymal and intrabronchial hemorrhage.1-3 It is not surprising, then, that the mainstay treatment in recent times has been nonsurgical therapy.Although most studies show historically high mortality rates (32% on the basis of pooled data from 30 studies and 1,047 patients from 1961 through 1984), recent increases in the effectiveness of surgical techniques have resulted in lower mortality rates for pulmonary embolectomies. 4,5 For example, a surgical approach described by Aklog and colleagues 6 resulted in an 11% mortality rate among 29 patients, over a 3-year period of study. All patients had anatomically extensive embolism and moderate-to-severe right ventricular (RV) dysfunction. Other investigators have shown similar results. For example, Lehnert and associates, in 33 patients who underwent embolectomy, achieved a 30-day mortality rate of 6% and a 12-year survival rate of 80%.7 Kadner and coworkers also produced a low mortality rate of just 8% in 25 patients over a 7-year period. Schoepf and colleagues' study of patients with RV enlargement showed a 30-day mortality rate of 15.6%, compared with 7.7% when RV enlargement was not present. 9The American College of Chest Physicians Evidence-Based Clinical Practice Guidelines recommend surgical pulmonary embolectomy in patients with acute pulmonary embolism (PE) associated with hypotension, if 1) patients have contraindications to thrombolysis; 2) patients have undergone failure of thrombolysis or catheter-assisted embolectomy; or 3) patients are in a state of shock that is likely to result in death before thrombolysis can take effect; and 4) the surgeon possesses appropriate expertise, and obtainable or accessible resources are ready for use.

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The process of corneal wound healing is complex and induces scar formation. Corneal scarring is a leading cause of blindness worldwide. The fibrotic healing of a major ocular wound disrupts the highly organized fibrillar collagen arrangement of the corneal stroma, rendering it opaque. The process of regaining this organized extracellular matrix (ECM) arrangement of the stromal layer to restore corneal transparency is complicated. The surface retention capacity of ocular drugs is poor, and there is a large gap between suitable corneal donors and clinical requirements. Therefore, a more efficient way of treating corneal scarring is needed. The eight major classes of interventions targeted as therapeutic tools for healing scarred corneas include those based on exosomes, targeted gene therapy, microRNAs, recombinant viral vectors, histone deacetylase inhibitors, bioactive molecules, growth factors, and nanotechnology. This review highlights the recent advancements in molecular therapeutics to restore a cornea without scarring. It also provides a scope to overcome the limitations of present studies and perform robust clinical research using these strategies.