Abstract
Simple limbal epithelial transplantation (SLET) is an ingenious, low cost and effective technique of limbal stem cell transplantation (LSCT) that is increasingly being undertaken in practice across the world. Since it was first described a decade ago, the technique has been performed in a variety of cases of limbal stem cell deficiency (LSCD) and has underwent several innovative modifications. Published literature on SLET has progressively increased over time and successful outcomes in various clinical scenarios have been reported. This concise review attempts to present a crisp account of SLET covering the indications and contraindications of performing the procedure; detailed account of pre-operative work up and preparation; surgical technique and its modifications; post-operative course, care and possible complications as well as published outcomes of surgery from across the world. Comparative analysis of various techniques of LSCT have been discussed and common concerns of surgeons practising or those who are planning to start practising SLET have been addressed. The authors hope that the pragmatic insights and pearls given at the end of the review will aid the surgeons in performing this technique to provide maximum benefit to patients suffering from the potentially blinding condition of LSCD.
Highlights
Simple limbal epithelial transplantation (SLET) is a relatively new technique of limbal stem cell transplantation first described by Sangwan et al in the year 2012 [1]
The cornea is covered by non-keratinised, stratified squamous epithelium which undergoes constant renewal by limbal stem cells (LSCs)
They give rise to the transient amplifying cells (TACs) which migrate centripetally along the basement membrane to replace the epithelial cells during normal hameostasis or following injury
Summary
Simple limbal epithelial transplantation (SLET) is a relatively new technique of limbal stem cell transplantation first described by Sangwan et al in the year 2012 [1]. Complications in the recipient eye include corneal perforation at the time of pannus dissection, post-operative keratitis, detached amniotic membrane and loss of limbal transplants. The pioneering work on SLET by Sangwan et al reported successful primary outcome of the procedure defined as a completely epithelialised, avascular and stable corneal surface at 6 weeks in all of their 6 patients. This was maintained at a mean follow up of 9.2 ± 1.9 months. In CLET, a tiny limbal biopsy from the healthy eye is cultured in a laboratory to create a multi layered sheet of corneal epithelium which is transplanted in the patient in a second surgery. Dissection under direct visualisation up to 1 mm into the clear cornea, in the plane of the insertion of the tenons capsule to the limbus is recommended
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