Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency

TLDR

The study introduces a novel limbal transplantation technique that merges advantages of existing methods while sidestepping their drawbacks. The technique involves harvesting a 2 × 2 mm donor limbal strip, dividing it into 8–10 pieces, and evenly distributing these onto an amniotic membrane placed on the cornea in a single‑stage procedure performed on six patients with unilateral total limbal stem cell deficiency. All six patients achieved complete, avascular, stable corneal epithelium within six weeks, with visual acuity improving to 20/60 or better in two‑thirds of eyes and no donor‑eye complications, demonstrating that the procedure is effective, tissue‑efficient, and does not require laboratory expansion.

Abstract

This study describes a novel surgical technique of limbal transplantation, which combines the benefits of existing techniques while avoiding their difficulties. Six patients with unilateral and total limbal stem cell deficiency following ocular surface burns underwent a single-stage procedure. A 2 × 2 mm strip of donor limbal tissue was obtained from the healthy eye and divided into eight to ten small pieces. After surgical preparation of the recipient ocular surface, these tiny limbal transplants were distributed evenly over an amniotic membrane placed on the cornea. After surgery, a completely epithelialised, avascular and stable corneal surface was seen in all recipient eyes by 6 weeks, and this was maintained at a mean ± SD follow-up of 9.2 ± 1.9 months. Visual acuity improved from worse than 20/200 in all recipient eyes before surgery to 20/60 or better in four (66.6%) eyes, while none of the donor eyes developed any complications. This technique requires less donor tissue than previously used for conventional autografting and does not need a specialist laboratory for cell expansion. Although long-term results are awaited, this simple limbal epithelial transplantation promises to be an easy and effective technique for treating unilateral limbal stem cell deficiency following ocular burns.