Simple limbal epithelial transplantation (SLET) in failed cultivated limbal epithelial transplantation (CLET) for unilateral chronic ocular burns

Basu, Sayan; Mohan, Sashwanthi; Bhalekar, Swapnil; Singh, Vivek; Sangwan, Veena

doi:10.1136/bjophthalmol-2017-311506

Cited by 37 publications

(36 citation statements)

References 18 publications

(6 reference statements)

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“…A direct comparison between SLET and CLAU performed on patients with the same etiology and in the same clinical setting supports SLET as an equally safe and effective treatment for LSCD . A primary success rate of 62.5% (n = 30) was also reported where SLET was performed in cases of failed CLET …”

Section: Resultsmentioning

confidence: 81%

“…Overall, SLET compares well with other procedures (CLAU, CLET, COMET) that use autologous tissue for treatment of LSCD, resulting in similar average primary and secondary criteria success rates. Importantly, SLET has now been validated in several larger studies and in several international centers since the first published report in 2012 . Many studies have reported long‐term success, with follow‐up periods of 12 to 59 months (Tables and 2) …”

Section: Resultsmentioning

confidence: 99%

“…One study directly compared SLET with CLAU, with 10 patients randomly assigned to each group . The Sangwan group in India published the most studies . Other centers in India, England, Brazil, Mexico, Thailand, and the United States also contributed.…”

Section: Characteristics Of Slet Studiesmentioning

confidence: 99%

“…It has been shown that SLET can be used in patients with LSCD following failure of treatment with CLET . At a mean follow‐up of 2.3 years, 80% of the 30 eyes treated by SLET maintained a successful outcome without complications.…”

Section: Etiology Of Cases Treated With Sletmentioning

confidence: 99%

“…The most common complications following SLET reported in the three largest follow‐up studies (involving 125, 68, and 30 patients) were focal recurrence of LSCD, progressive conjunctivalization, progressive symblepharon, and keratitis (Table ) . More unusual complications were loss of transplants following surgery, epithelial defects that persisted for more than 6 months, and pyogenic granuloma …”

Section: Risk Factors For Failure and Complicationsmentioning

confidence: 99%

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Simple limbal epithelial transplantation: Current status and future perspectives

Jackson

Ernø

Ringstad

et al. 2019

Stem Cells Translational Medicine

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Damage to limbal stem cells as a result of injury or disease can lead to limbal stem cell deficiency (LSCD). This disease is characterized by decreased vision that is often painful and may progress to blindness. Clinical features include inflammation, neovascularization, and persistent cornea epithelial defects. Successful strategies for treatment involve transplantation of grafts harvested from the limbus of the alternate healthy eye, called conjunctival‐limbal autograft (CLAU) and transplantation of limbal cell sheets cultured from limbal biopsies, termed cultured limbal epithelial transplantation (CLET). In 2012, Sangwan and colleagues presented simple limbal epithelial transplantation (SLET), a novel transplantation technique that combines the benefits of CLAU and CLET and avoids the challenges associated with both. In SLET a small biopsy from the limbus of the healthy eye is divided and distributed over human amniotic membrane, which is placed on the affected cornea. Outgrowth occurs from each small explant and a complete corneal epithelium is typically formed within 2 weeks. Advantages of SLET include reduced risk of iatrogenic LSCD occurring in the healthy cornea at harvest; direct transfer circumventing the need for cell culture; and the opportunity to perform biopsy harvest and transplantation in one operation. Success so far using SLET is comparable with CLAU and CLET. Of note, 336 of 404 (83%) operations using SLET resulted in restoration of the corneal epithelium, whereas visual acuity improved in 258 of the 373 (69%) reported cases. This review summarizes the results of 31 studies published on SLET since 2012. Progress, advantages, challenges, and suggestions for future studies are presented.

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Section: Resultsmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Slet Studiesmentioning

confidence: 99%

Section: Etiology Of Cases Treated With Sletmentioning

confidence: 99%

Section: Risk Factors For Failure and Complicationsmentioning

confidence: 99%

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Simple limbal epithelial transplantation: Current status and future perspectives

Jackson

Ernø

Ringstad

et al. 2019

Stem Cells Translational Medicine

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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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Current Perspectives of Limbal-Derived Stem Cells and its Application in Ocular Surface Regeneration and Limbal Stem Cell Transplantation

Singh

Tiwari

Kethiri

et al. 2021

Stem Cells Translational Medicine

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Limbal stem cells are involved in replenishing and maintaining the epithelium of the cornea. Damage to the limbus due to chemical/physical injury, infections, or genetic disorders leads to limbal stem cell deficiency (LSCD) with partial or total vision loss.Presently, LSCD is treated by transplanting limbal stem cells from the healthy eye of the recipient, living-related, or cadaveric donors. This review discusses limbal-derived stem cells, the importance of extracellular matrix in stem cell niche maintenance, the historical perspective of treating LSCD, including related advantages and limitations, and our experience of limbal stem cell transplantation over the decades.

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Simple limbal epithelial transplantation (SLET) in failed cultivated limbal epithelial transplantation (CLET) for unilateral chronic ocular burns

Abstract: SLET is an effective alternative to CLET in eyes with recurrence of LSCD after previously failed CLET procedures. Since SLET is single-staged and less expensive, it is probably preferable to repeating CLET.

Cited by 37 publications

References 18 publications

Simple limbal epithelial transplantation: Current status and future perspectives

Simple limbal epithelial transplantation: Current status and future perspectives

Outcomes of Limbal Stem Cell Transplant

Current Perspectives of Limbal-Derived Stem Cells and its Application in Ocular Surface Regeneration and Limbal Stem Cell Transplantation

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