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Simple limbal epithelial transplantation (SLET) in failed cultivated limbal epithelial transplantation (CLET) for unilateral chronic ocular burns
  1. Sayan Basu1,2,
  2. Sashwanthi Mohan3,
  3. Swapnil Bhalekar2,
  4. Vivek Singh1,2,
  5. Virender Sangwan1,2
  1. 1Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
  2. 2Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
  3. 3Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
  1. Correspondence to Dr Virender Sangwan, Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad 500034, India; vsangwan{at}


Aims Cultivated limbal epithelial transplantation (CLET) fails in around 20%–30% of cases. This study aimed to report the clinical outcomes of autologous simple limbal epithelial transplantation (SLET) in eyes with recurrent unilateral limbal stem cell deficiency (LSCD) due to failure of CLET.

Methods This was a prospective case series which included 30 eyes of 30 patients who underwent SLET between 2010 and 2016 after failure of one (n=24) or two (n=6) previous CLET procedures for chronic unilateral ocular burns. The primary outcome measure was success of SLET defined on the basis of relative improvement in five objective criteria: best corrected visual acuity (BCVA), and grades of symblepharon, corneal conjunctivalisation, vascularisation and opacification.

Results At a mean follow-up of 2.3 years, 24 (80%) of the 30 eyes maintained a successful outcome. Kaplan-Meier analysis showed a 5-year survival probability of 77%±8%. At 1 year postoperatively statistically significant improvement was noted in BCVA (logarithm of the minimum angle of resolution of 3 to 1) and in the median grades of corneal conjunctivalisation (2 to 0), vascularisation (2 to 0) and opacification (2 to 1) (P≤0.0026). In 62.5% of successful cases, BCVA improved to 20/200 or better. The success rate of SLET in failed CLET was better than that of repeat CLET (53.5%, P=0.011). None of the donor eyes developed any complications.

Conclusion SLET is an effective alternative to CLET in eyes with recurrence of LSCD after previously failed CLET procedures. Since SLET is single-staged and less expensive, it is probably preferable to repeating CLET.

  • cornea
  • ocular surface
  • stem cells
  • treatment surgery

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  • SB and SM contributed equally.

  • 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.

  • Funding This work was funded by the Hyderabad Eye Research Foundation, Hyderabad, India, and Champalimaud Foundation, Lisbon, Portugal. The sponsoring organisations had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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

  • Data sharing statement There are no unpublished data from this study.

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