Simple limbal epithelial transplantation: a review on current approach and future directions

Borroni, Davide; Wowra, Bogumił; Romano, Vito; Boyadzhieva, Mila; Ponzin, Diego; Ferrari, Stefano; Ahmad, Sajjad; Parekh, Mohit

doi:10.1016/j.survophthal.2018.05.003

Cited by 19 publications

(14 citation statements)

References 32 publications

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“…The donor tissue was cut into small pieces and these explants placed epithelial side up on top of the amniotic membrane in a circular manner around the cornea. This technique has been further explored by a number of studies, such as Shanbhag et al 78 and Borroni et al 79 Both these studies show SLET surgery to be an effective and safe surgical technique. One retrospective multicentre study using 68 eyes showed the success of SLET in 57 cases (83.8%) with a survival probability of greater than 80% at one-year post operatively.…”

Section: Ocular Surface Reconstruction: Graftmentioning

confidence: 99%

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

Walkden¹

2020

OPTH

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The aim of this paper is to provide a succinct literature review of the different clinical applications for AMT usage in an ophthalmic setting, ranging from commonly used applications to less mainstream approaches. The hope is that this review enables the reader to have a better understanding of the biological properties of amnion as well as the indications and scenarios in which AMT can be used, whilst presenting relevant evidence from within the literature which may be of interest. We also provide an update on the methods of preservation of amniotic membrane and the application methodologies. Methods: Literature search. A PubMed search was performed using the search terms "amniotic membrane transplant", "amnion AND cornea", amnion AND ophthalmology", "amnion AND ocular surface" and "Amnion AND eye". A full review of the literature using the PubMed database was conducted up until 01/05/20. The articles used were written in English, with all articles accessed in full. Both review articles and original articles were used for this review. All full publications related to ophthalmology were considered.

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Section: Ocular Surface Reconstruction: Graftmentioning

confidence: 99%

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

Walkden¹

2020

OPTH

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“…2,5,29 Both CLET and SLET have limitations on the damage to the contralateral eye in unilateral LSCD patients and immunological rejection after allotransplantation in bilateral LSCD patients. 10,37 COMET has remained a significant strategy as it saves the risk of inflicting damage to the alternate healthy eye to harvest limbal tissues for CLET or SLET procedures and has a lower risk of rejection. 38 However, it faces extreme challenges in terms of potential murine infectious diseases in using 3T3 feeder cells and various degrees of postoperative corneal neovascularization.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 However, in bilateral LSCD patients, the outcomes were less impressive on account of the severe immune rejection after allogeneic limbal transplantation. 10…”

Section: Introductionmentioning

confidence: 99%

Subconjunctival Injection of Transdifferentiated Oral Mucosal Epithelial Cells for Limbal Stem Cell Deficiency in Rats

Xiao

Xie

Liu

et al. 2020

J Histochem Cytochem.

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Rat limbal niche cells (LNCs) have been proven to induce transdifferentiation of oral mucosal epithelial cells (OMECs) into corneal epithelial-like cells termed transdifferentiated oral mucosal epithelial cells (T-OMECs). This investigation aimed to evaluate the effect of subconjunctival T-OMEC injections on alkali-induced limbal stem cell deficiency (LSCD) in rats. LNCs were cocultured with OMECs in the Transwell system to obtain T-OMECs, with NIH-3T3 cells serving as a control. Subconjunctival injection of single T-OMEC or OMEC suspension was performed immediately after corneal alkali injury. T-OMECs were prelabeled with the fluorescent dye CM-DiI in vitro and tracked in vivo. Corneal epithelial defect, opacity, and neovascularization were quantitatively analyzed. The degree of corneal epithelial defect (from day 1 onward), opacity (from day 5 onward), and neovascularization (from day 2 onward) was significantly less in the T-OMEC group than in the OMEC group. Cytokeratin 12 (CK12), pigment epithelium–derived factor, and soluble fms-like tyrosine kinase-1 were expressed at a higher rate following T-OMEC injection. Some CM-DiI-labeled cells were found to be coexpressed with CK12, Pax6, and ΔNp63α in the corneal epithelium after subconjunctival injection. Subconjunctival injection of T-OMECs prevents conjunctival invasion and maintains a normal corneal phenotype, which might be a novel strategy in the treatment of LSCD:

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“…Techniques have evolved from conjunctival-limbal autografting (CLAU) to cultivated limbal stem cell transplantation (CLET). To overcome the drawbacks of the large biopsy of healthy tissue required for CLAU and the infrastructure and regulatory requirements for CLET, a technique of in situ limbal stem cell expansion, termed 'simple limbal epithelial transplantation' (SLET), has been developed [2][3][4][5]. A recent meta-analysis compared cultivated limbal transplant techniques and direct limbal transplantations (including SLET) and found more favorable outcomes for direct limbal transplantation [6].…”

Section: Introductionmentioning

confidence: 99%

In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET

Pedrotti

Chierego

Cozzini

et al. 2020

JCM

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Examination of the corneal surface by in vivo confocal microscopy (IVCM) allows for objective identification of corneal and conjunctival cell phenotypes to evaluate different epithelialization patterns. Detection of a corneal-conjunctival epithelial transition could be considered as a sign of restored epithelial function following simple limbal epithelial transplantation (SLET). This is a prospective, interventional case series. We assessed patients with limbal stem cell deficiency (LSCD) by IVCM, preoperatively and at monthly intervals following SLET. Sectors in the central and peripheral cornea were scanned. Immediately upon detection of multi-layered cells with the epithelial phenotype in the central cornea and confirmation of epithelial transition in all corneal sectors, the decision for keratoplasty was taken. Ten patients were enrolled. After SLET, epithelial phenotype in the central cornea and an epithelial transition were identified within six and nine months in seven and one patients, respectively. One patient was a partial success and one failed. Five patients underwent keratoplasty, with stable results up to 12 months. Identification of the epithelial transition zone by IVCM permits assessment of the efficacy of SLET, enabling subsequent planning of keratoplasty for visual rehabilitation. The stability of the corneal surface following keratoplasty confirms that the renewal of the corneal epithelium was effectively retained.

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Simple limbal epithelial transplantation: a review on current approach and future directions

Cited by 19 publications

References 32 publications

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

Subconjunctival Injection of Transdifferentiated Oral Mucosal Epithelial Cells for Limbal Stem Cell Deficiency in Rats

In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET

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