Autologous simple limbal epithelial transplantation for unilateral limbal stem cell deficiency: multicentre results

Vazirani, Jayesh; Ali, Mohammed; Sharma, Namrata; Gupta, Nidhi; Mittal, Vikas; Atallah, Marwan; Amescua, Guillermo; Chowdhury, Tuhin; Abdala-Figuerola, Alexandra; Ramírez-Miranda, Arturo; Navas, Alejandro; Graue-Hernández, Enrique O; Chodosh, James

doi:10.1136/bjophthalmol-2015-307348

Cited by 102 publications

(101 citation statements)

References 21 publications

(26 reference statements)

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“…SLET unlike CLET obviates the need for clean room facilities and cell culture technicians, therefore becoming much more accessible 4. Both CLET and SLET procedures are successful in around 70% of patients with LSCD from chemical burns 5–7…”

Section: Introductionmentioning

confidence: 99%

Synthetic biodegradable alternatives to the use of the amniotic membrane for corneal regeneration: assessment of local and systemic toxicity in rabbits

et al. 2018

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AimThe aim of this study was to assess the local and systemic response to poly-lactic co-glycolic acid (PLGA) 50:50 membranes, developed as synthetic biodegradable alternatives to the use of human donor amniotic membrane in the treatment of limbal stem cell deficiency.MethodsPLGA membranes of 2 cm diameter and 50 µm thickness were placed on one eye of rabbits and secured in place using fibrin glue and a bandage contact lens, suturing the eye close with a single stitch. Control animals were treated identically, with the absence of the membranes. Plain and microfabricated electrospun membranes (containing micropockets which roughly emulate the native limbal niche) were examined over 29 days. All animals were subjected to a detailed gross and histopathological observation as well as a detailed examination of the eye.ResultsApplication of the membranes both with and without microfabricated pockets did not adversely affect animal welfare. There was complete degradation of the membranes by day 29. The membranes did not induce any significant local or systemic toxicity. Conjunctival congestion and corneal vascularisation were noted in a few control and PLGA-treated animals. Intraocular pressure was normal and the retinal status was unaltered. The ocular surface was clear and intact in all animals by the end of 29 days.ConclusionMembranes of 50:50 PLGA can be safely applied to rabbit corneas without inducing any local or systemic toxicity and these break down completely within 29 days.

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Section: Introductionmentioning

confidence: 99%

Synthetic biodegradable alternatives to the use of the amniotic membrane for corneal regeneration: assessment of local and systemic toxicity in rabbits

et al. 2018

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“…Further results of success of SLET in effectively treating unilateral LSCD following ocular burns have also been reported in recent times. [13141516171819] Results from a multicenter retrospective study have described nearly 83% success rate of SLET, suggesting it to be comparable to, or even better than, previous techniques. There is, however, no comparison of the study results with other techniques and only historical data have been used.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of symblepharon preoperatively has been reported to be a risk factor for failure of SLET. [1319] The epithelial stem cells from the limbus, presumably serve as a barrier to conjunctivalization of the cornea and thus are successful in correcting symblepharon. Meallet et al .…”

Section: Discussionmentioning

confidence: 99%

“…[19] Equally promising outcomes have been reported in multicenter studies with regard to regeneration of an avascular, healthy corneal surface. [13]…”

Section: Discussionmentioning

confidence: 99%

“…[13141516171819] Clinical success rates and visual acuity improvement have been reported to be equal to or better than those reported with earlier techniques. [13]…”

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Preliminary results from the comparison of simple limbal epithelial transplantation with conjunctival limbal autologous transplantation in severe unilateral chronic ocular burns

Arora

Dokania

Manudhane

et al. 2017

Indian J Ophthalmol

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Purpose:To compare the safety, efficacy, and clinical outcomes of simple limbal epithelial transplantation (SLET) with conjunctival-limbal autologous transplantation (CLAU) in severe unilateral ocular chemical burns.Materials and Methods:Twenty patients of unilateral chronic ocular burns with more than 270° limbal stem cell deficiency and a healthy fellow eye were divided into two groups – ten patients of Group A underwent SLET while ten patients of Group B were operated for CLAU. Patients were followed up for 6 months and assessed for a stable epithelialized ocular surface, extent of reduction in vascularization and forniceal reconstruction, improvement in corneal clarity and visual acuity.Results:A stable epithelialized corneal surface was obtained in all patients, with a significant reduction in the mean clock hours of vascularization in both the groups (P < 0.001). The mean symblepharon score showed a statistically significant reduction from 1.80 ± 1.14 to 0.30 ± 0.63 in Group A and 1.70 ± 1.06 to 0.15 ± 0.24 in Group B at 6 months. Corneal clarity, as well as best-corrected visual acuity, showed a statistically significant improvement in both the groups.Conclusion:Both the procedures, SLET and CLAU, were equally effective in achieving a stable ocular surface, forniceal reconstruction, and regression of corneal vascularization. The requirement of minimal donor tissue in SLET makes it a preferred option over CLAU in cases of uniocular chronic ocular burns.

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Outcomes of Limbal Stem Cell Transplant

Chauhan

Yung

et al. 2020

JAMA Ophthalmol

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IMPORTANCE Limbal stem cell transplant (LSCT) can be categorized as direct autologous limbal transplant (AULT), direct allogenic limbal transplant (ALLT), cultivated autologous limbal stem cells transplant (cAULT), and cultivated allogenic limbal stem cells transplant (cALLT). To our knowledge, there is no study directly comparing the outcomes and complications of these procedures.OBJECTIVE To evaluate the outcomes of different LSCT procedures.DATA SOURCE We searched PubMed, EMBASE, Web of Science, and Cochrane without language filter for peer-reviewed articles about LSCT. The latest search was performed on June 30, 2019.STUDY SELECTION Clinical studies with the outcome of at least 20 eyes after LSCT were included. Animal studies and studies of other surgical interventions were excluded. DATA EXTRACTION AND SYNTHESISTwo reviewers independently abstracted the data from each study. Heterogeneity was evaluated with the I 2 statistic, and a meta-analysis was performed using the random-effects model. MAIN OUTCOMES AND MEASURESOutcome measures included the improvement of ocular surface, visual acuity (VA), and adverse events of recipient eyes and donor eyes.RESULTS Forty studies (2202 eyes) with a mean (SD) follow-up of 31.3 (20.9) months met the inclusion criteria. The mean (SD) age of study participants was 38.4 (13.1) years, and men accounted for 74%. The number of eyes that underwent AULT, ALLT, cAULT, and cALLT were 505, 742, 771, and 184, respectively. Improvement of the ocular surface was achieved in 74.5% of all eyes, 85.7% of eyes after AULT (95% CI, 79.5%-90.3%), 84.7% after cAULT (95% CI, 77.2%-90.0%), 57.8% after ALLT (95% CI, 49.0%-66.1%), and 63.2% after cALLT (95% CI, 49.3%-75.2%). Autologous limbal transplantation resulted in a greater VA improvement rate (76%) than did the other 3 procedures (cAULT: 56.4%; ALLT: 52.3%; cALLT: 43.3%; all P < .001). The most common adverse events in all recipient eyes were recurrent/persistent epithelial erosion (10.5%; 95% CI, 7.2%-23.3%) and elevated intraocular pressure (intraocular pressure, 1.7%; 95% CI, 0.5%-7.8%). Patients who underwent ALLT had the highest rate of recurrent epithelial erosion (27.8%; 95% CI, 17.1%-41.9%) and intraocular pressure elevation (6.3%; 95% CI, 1.8%-19.4%). CONCLUSIONS AND RELEVANCEThese findings suggest LSCT can improve or stabilize the corneal surface with a low rate of severe ocular complications and that autologous LSCT may have a higher success rate and fewer complications than allogenic LSCT.

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Autologous simple limbal epithelial transplantation for unilateral limbal stem cell deficiency: multicentre results

Abstract: Autologous SLET is an effective and safe modality for treatment of unilateral LSCD. Clinical success rates and visual acuity improvement are equal to or better than those reported with earlier techniques.

Cited by 102 publications

References 21 publications

Synthetic biodegradable alternatives to the use of the amniotic membrane for corneal regeneration: assessment of local and systemic toxicity in rabbits

Synthetic biodegradable alternatives to the use of the amniotic membrane for corneal regeneration: assessment of local and systemic toxicity in rabbits

Preliminary results from the comparison of simple limbal epithelial transplantation with conjunctival limbal autologous transplantation in severe unilateral chronic ocular burns

Outcomes of Limbal Stem Cell Transplant

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