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Autologous simple limbal epithelial transplantation for unilateral limbal stem cell deficiency: multicentre results
  1. Jayesh Vazirani1,
  2. Mohammed Hasnat Ali2,
  3. Namrata Sharma3,
  4. Nidhi Gupta4,
  5. Vikas Mittal5,
  6. Marwan Atallah6,
  7. Guillermo Amescua6,
  8. Tuhin Chowdhury7,
  9. Alexandra Abdala-Figuerola8,
  10. Arturo Ramirez-Miranda8,
  11. Alejandro Navas8,
  12. Enrique O Graue-Hernández8,
  13. James Chodosh9
  1. 1Cornea and Anterior Segment Services, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
  2. 2Department of Clinical epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, Telangana, India
  3. 3Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
  4. 4Dr. Shroff's Charity Eye Hospital, New Delhi, India
  5. 5Sanjivni Eye Care, Ambala, Haryana, India
  6. 6Bascom Palmer Eye Institute, Miami, Florida, USA
  7. 7Disha Eye Hospitals, Kolkata, West Bengal, India
  8. 8Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico
  9. 9Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
  1. Correspondence to Dr Jayesh Vazirani, Cornea and Anterior Segment Services, L V Prasad Eye Institute, GMR Varalakshmi Campus, Hanumanthawaka Junction, Visakhapatnam 530040, Andhra Pradesh, India; jayeshvazirani{at}gmail.com

Abstract

Purpose To report outcomes of autologous simple limbal epithelial transplantation (SLET) performed for unilateral limbal stem cell deficiency (LSCD) at multiple centres worldwide.

Methods 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.

Results 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.

Conclusion 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.

  • Stem Cells
  • Treatment Surgery
  • Cornea

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