Abstract
Purpose:
To report the clinical outcomes of simple limbal epithelial transplantation (SLET) in patients with limbal stem cell deficiency (LSCD).
Methods:
Retrospective case series of patients with LSCD who underwent either Auto-SLET or Allo-SLET at a tertiary center in Mexico from 2020 to 2023. Demographic and clinical data, including underlying etiology, best corrected visual acuity, and graft survival, were collected and analyzed.
Results:
Eighteen eyes of 18 patients were studied, with a mean age of 34.05 ± 22.88 years. The underlying etiologies of LSCD were alkali chemical injury (n = 10, 55.55%), acid chemical injury (n = 3, 16.66%), pterygium (n = 2, 11.11%), thermal burn (n = 2, 11.11%), and Stevens–Johnson syndrome (SJS) (n = 1, 5.55%). The mean follow-up was 26.05 ± 11.09 months. Auto-SLET and Allo-SLET were performed in 88.88% and 11.11% of the cases, respectively. Clinical success was achieved in 72.22% of cases, with failures associated with acid chemical injury (n = 2), alkali chemical injury (n = 2), and SJS (n = 1). Best-corrected visual acuity (BCVA) improved significantly from 1.58 ± 0.81 logMAR to 1.11 ± 0.75 logMAR (P = 0.05). The mean survival time of all SLET procedures was 623.38 ± 458.70 days. Kaplan–Meier analysis showed varied survival times across different etiologies: alkali injury (719.5 ± 444.3 days), pterygium (328 ± 118.79 days), acid injury (593 ± 831.7 days), thermal burn (663 ± 39.59 days), and SJS (265 days), with an overall survival probability of 72% at 500 days.
Conclusions:
Clinical success was achieved in 72.22% of cases. SLET and derived techniques have proven safe and effective as viable treatments for LSCD. This relatively straightforward and efficient technique has yielded positive outcomes across various etiologies of LSCD in our population.
Limbal stem cell deficiency (LSCD) is a challenging ocular surface disease caused by a decrease in the population and function of the corneal epithelial stem cells, leading to the inability to sustain the normal homeostasis of the corneal epithelium.[1] Clinically, LSCD is defined by the triad of corneal neovascularization, conjunctivalization, and recurrent/persistent corneal epithelial defects in persistent ocular surface inflammation.[1,2] These clinical findings manifest as photophobia, visual fluctuations, and foreign body sensation.[3] Severe LSCD leads to scarring and represents a leading cause of blindness worldwide.[4]
The etiology of LSCD is multifactorial, encompassing both hereditary and acquired causes. Significant contributors include hereditary conditions such as epidermolysis bullosa, xeroderma pigmentosum, congenital keratosis, and congenital aniridia.[1] Acquired causes are further classified into immune-mediated diseases like graft-versus-host disease, mucous membrane pemphigoid, and Stevens–Johnson syndrome (SJS), as well as nonimmune-mediated factors including chemical or thermal burns, contact lens-induced trauma, surgical interventions involving the limbus, medication-induced toxicity, and infectious or bullous keratopathy.[1] Current surgical options for ocular surface reconstruction include conjunctivolimbal autografts (CLAU or living-related CLAU), keratolimbal allografts, cultivated oral mucosa transplantation, cultivated limbal epithelial transplantation (CLET), simple oral mucosal transplantation, and simple limbal epithelial transplantation (SLET).[5–7] In SLET, the damage to the donor eye is negligent because of the small size of the specimen taken. Compared to cultivated ex vivo expansion protocols, SLET overcomes limitations regarding infrastructure and cost to the patient and decreases the number of surgical steps and time to rehabilitation. Several technique modifications may offer advantages in selected patients, such as Allo-SLET.[8,9] This study presents the clinical outcomes of 18 consecutive cases of LSCD treated with either Auto-SLET or Allo-SLET in a Mexican tertiary center. The patients included represent a variety of etiologies and severity profiles, including chemical burns, pterygium, and SJS, providing a broad overview of the potential indications and challenges associated with SLET in real-world settings.