Abstract
ObjectiveTo report the clinical outcomes of a novel surgical technique, namely simple limbal epithelial transplantation (SLET), for the treatment of limbal stem cell deficiency (LSCD).MethodsThirteen patients (13 eyes) with LSCD who underwent autologous (10 eyes) or allogeneic (3 eyes) modified SLET between 2018 and 2021 were enrolled in this study. Grades of symblepharon, corneal conjunctivalization, vascularization, opacification, and visual acuity (VA) were evaluated preoperatively and postoperatively. In 2 cases, in vivo confocal microscopy (IVCM) and impression cytology (IC) were performed to assess the proliferation and degeneration of limbal tissue.ResultsAt a postoperative follow-up of 6.5±5.3 (range, 2–20) months, 10 (10/13, 76.92%) eyes maintained a successful outcome. The grades of symblepharon, corneal conjunctivalization, vascularization, and opacification were significantly improved after SLET (P<0.05). Two-line improvement in VA was found in 6 (6/10, 60%) eyes of the successful cases. Recurrence of LSCD occurred in 3 (3/13, 23.08%) eyes, and conjunctival cyst occurred in 1 patient. After SLET, the morphology and structure of corneal epithelial cells and epithelial transition around the limbal tissue fragments were detected by IVCM and IC.ConclusionsOur findings suggest that the SLET is a safe and effective technique for the treatment of LSCD. The corneal stroma and hAM can provide protection and nutrition for the limbal stem cells (LSCs) without negatively influencing the clinical outcomes. IVCM and IC after SLET can evaluate the effectiveness of surgery and the transition of LSCs and corneal epithelial cells.
Highlights
Limbal stem cells (LSCs) reside in the basal epithelium of the limbus, which is the boundary between the cornea and conjunctiva [1]
limbal stem cell deficiency (LSCD) can be categorized into 3 stages based on the extent of corneal and limbal involvement detected by clinical examinations [5]
Impression cytology (IC) and in vivo confocal microscopy (IVCM) may reflect more accurately the phenotype of the epithelium; both are considered more sensitive in diagnosis [5, 6]
Summary
Limbal stem cells (LSCs) reside in the basal epithelium of the limbus, which is the boundary between the cornea and conjunctiva [1]. The importance of LSCs in maintaining the homeostasis of corneal epithelium and wound healing has been confirmed in a variety of researches [2, 3]. As a result of injury or disease, can lead to limbal stem cell deficiency (LSCD). Clinical features of LSCD include corneal conjunctivalization, neovascularization, recurrent or persistent epithelial defects (PED), and scarring, leading to pain, impairment of vision, and may even progress to blindness [4]. LSCD can be categorized into 3 stages based on the extent of corneal and limbal involvement detected by clinical examinations [5]. There are limitations of slit-lamp examination in the diagnosis of LSCD owning to the signs of abnormal epithelium. Impression cytology (IC) and in vivo confocal microscopy (IVCM) may reflect more accurately the phenotype of the epithelium; both are considered more sensitive in diagnosis [5, 6]
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