Br J Ophthalmol 96:931-934 doi:10.1136/bjophthalmol-2011-301164
  • Innovations

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

  1. Dorairajan Balasubramanian4
  1. 1Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, India
  2. 2Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, L V Prasad Eye Institute, Hyderabad, India
  3. 3Department of Materials Science and Engineering, University of Sheffield, Sheffield, UK
  4. 4Champalimaud Translational Centre for Eye Research, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
  1. Correspondence to Dr Virender S Sangwan, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Road No 2, Banjara Hills, Hyderabad, India; vsangwan{at}
  1. Contributors The corresponding author states that authorship credit of this manuscript was based on: (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published. All listed authors met conditions 1, 2 and 3. All persons designated as authors qualify for authorship, and all those who qualify are listed. Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content.

  • Accepted 17 January 2012
  • Published Online First 10 February 2012


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.


  • All the authors (VS, SB, SM, DB) contributed equally to the study.

  • Funding This work was funded by the Department of Biotechnology, New Delhi, India; Champalimaud Foundation, Lisbon; Portugal, and the Hyderabad Eye Research Foundation, Hyderabad, India. None of these had any role in the design, collection, analysis and interpretation of the data.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved prospectively by the Institutional Review Board (IRB) and the Institute Committee for Stem Cell Research and Therapy (ICSCRT), L V Prasad Eye Institute, Hyderabad, India. The study followed the tenets of the Declaration of Helsinki, and informed written consent was obtained from all patients enrolled in this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors are committed to make materials, data and associated protocols promptly available to others without preconditions.

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