Simple limbal epithelial transplantation (SLET) : Asimple technique for the treatment of unilateral complete limbal stem cell deficiency. Video article

Abstract

The aim of simple limbal epithelial transplantation (SLET) is the regeneration of the corneal surface in unilateral complete limbal stem cell deficiency (LSCD). SLET is indicated for unilateral complete LSCD. Contraindications include bilateral LSCD, severe corneal thinning, pronounced keratoconjunctivitis sicca, chronic inflammatory condition of the ocular surface, malposition of the eyelids and pronounced adhesions of the conjunctiva with trichiasis. A1‑h biopsy is obtained from the superior limbus of the healthy donor eye. A360° peritomy is performed on the LSCD eye and pannus tissue covering the cornea is removed. An amniotic membrane (AM) is glued to the corneal surface with fibrin. The donor tissue is then divided into 8-10 small pieces, which are placed on the AM sparing the visual axis and fixed by fibrin glue. Acontact lens is placed on the eye. Asurgical video, which is available online, shows the surgical technique in detail. Examinations are necessary within the first postoperative week and 1 month after SLET, then every 3 months within the first postoperative year. Antibiotic eye drops should be applied 5times daily until complete epithelialization. Topical steroids should be applied 6times daily in the early postoperative period and can be tapered thereafter. Artificial tears can improve epithelial healing. Ideally, all eye drops should be preservative-free. The contact lens can be removed after 7-10days. The AM dissolves within afew weeks. An epithelialization of the corneal surface can be observed by the second postoperative week. Arecent systematic review reported astable epithelialized corneal surface in 78% of SLET cases after 1.5years. An improvement of visual acuity of at least two lines was found in 69% of SLET cases.