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

• Published in: British journal of ophthalmology Vol. 100; no. 10; p. 1416
• Main Authors: Vazirani, Jayesh, Ali, Mohammed Hasnat, Sharma, Namrata, Gupta, Nidhi, Mittal, Vikas, Atallah, Marwan, Amescua, Guillermo, Chowdhury, Tuhin, Abdala-Figuerola, Alexandra, Ramirez-Miranda, Arturo, Navas, Alejandro, Graue-Hernández, Enrique O, Chodosh, James
• Format: Journal Article
• Language: English
• Published: England 01-10-2016
• Subjects: Adolescent; Adult; Aged; Burns, Chemical - diagnosis; Burns, Chemical - surgery; Cells, Cultured; Child; Child, Preschool; Corneal Diseases - diagnosis; Corneal Diseases - surgery; Corneal Transplantation - methods; Epithelium, Corneal - cytology; Epithelium, Corneal - transplantation; Eye Burns - diagnosis; Eye Burns - surgery; Female; Follow-Up Studies; Graft Survival; Humans; Limbus Corneae - cytology; Limbus Corneae - surgery; Male; Middle Aged; Retrospective Studies; Time Factors; Transplantation, Autologous; Treatment Outcome; Visual Acuity; Young Adult; Stem Cells; Cornea; Treatment Surgery
• ISSN: 1468-2079
• DOI: 10.1136/bjophthalmol-2015-307348

To report outcomes of autologous simple limbal epithelial transplantation (SLET) performed for unilateral limbal stem cell deficiency (LSCD) at multiple centres worldwide.
In this retrospective, multicentre, interventional case series, records of patients who had undergone autologous SLET for unilateral LSCD, with a minimum of 6 months of follow-up, were reviewed. The primary outcome measure was clinical success, defined as a completely epithelised, avascular corneal surface. Kaplan-Meier survival curves were constructed and survival probability was calculated. A Cox proportional hazards analysis was done to assess association of preoperative characteristics with risk of failure. Secondary outcome measures included the percentage of eyes achieving visual acuity of 20/200 or better, percentage of eyes gaining two or more Snellen lines and complications encountered.
68 eyes of 68 patients underwent autologous SLET, performed across eight centres in three countries. Clinical success was achieved in 57 cases (83.8%). With a median follow-up of 12 months, survival probability exceeded 80%. Presence of symblepharon (HR 5.8) and simultaneous keratoplasty (HR 10.8) were found to be significantly associated with a risk of failure. 44 eyes (64.7%) achieved a visual acuity of 20/200 or better, and 44 eyes (64.7%) gained two or more Snellen lines. Focal recurrences of pannus were noted in 21 eyes (36.8%) with clinical success.
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.