Efficacy and outcome of simple limbal epithelial transplantation for limbal stem cell deficiency verified by epithelial phenotypes integrated with clinical evaluation

Pinnita Prabhasawat; Chareenun Chirapapaisan; Panotsom Ngowyutagon; Pattama Ekpo; Wimolwan Tangpagasit; Kaevalin Lekhanont; Rosanun Sikarinkul; Sutthicha Matamnan; Chawikan Boonwong; Warinyupa Pinitpuwadol; Ranida Thamphithak; Nutchaya Sukon; Nutnicha Neti

doi:10.1016/j.jtos.2021.06.012

Efficacy and outcome of simple limbal epithelial transplantation for limbal stem cell deficiency verified by epithelial phenotypes integrated with clinical evaluation

Ocul Surf. 2021 Oct:22:27-37. doi: 10.1016/j.jtos.2021.06.012. Epub 2021 Jun 30.

Affiliations

¹ Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
² Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: chareenun.chi@mahidol.edu.
³ Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Research Division, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
⁴ Department of Ophthalmology, Faculty of Medicine, Thammasat University, Prathumthani, Thailand.
⁵ Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
⁶ Department of Ophthalmology, Golden Jubilee Medical Center, Mahidol University, Thailand.
⁷ Research Division, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

PMID: 34214675
DOI: 10.1016/j.jtos.2021.06.012

Abstract

Purpose: To evaluate the efficacy and outcome of simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD) using epithelial phenotype detection integrated with clinical manifestation.

Methods: This prospective multicenter study included patients with LSCD who underwent autologous SLET (autoSLET) and living-related allogenic SLET (Lr-alloSLET). All patients were assessed by slit-lamp biomicroscopy, in vivo confocal microscopy (IVCM), and impression cytology with immunofluorescence staining (ICIF) before and after surgery. The criteria for success were the presence of a clinically non-conjunctivalized cornea and corneal epithelium detected by IVCM or ICIF. Otherwise, the case would be considered a failure. Visual improvement and risk factors for SLET failure were analyzed.

Results: A total of 28 eyes of 26 patients (11 autoSLET and 17 Lr-alloSLET) were included. The median age was 53 years (range, 35-63), and the follow-up time was 29.5 months (range, 17.5-39.8). The overall survival rate was 89.3% at 2 years and 75.6% at 3 years with no difference between autoSLET and Lr-alloSLET (p = 0.24). Seven eyes subsequently underwent penetrating keratoplasty. Immunohistochemistry analysis showed that all corneal buttons had corneal epithelium and limbal stem cell markers. Visual improvement was achieved in both SLET groups (p < 0.001). Failed SLET developed between 5 and 32 months postoperatively. However, absolute risk factors for SLET failure were unidentified.

Conclusion: The efficacy of autoSLET and Lr-alloSLET for LSCD was excellent. Limbal explants can regenerate and restore the corneal surface while maintaining the characteristics of limbal stem cells as shown by epithelial phenotype detection and immunohistochemistry integrated with clinical evaluation.

Keywords: Autologous simple limbal epithelial transplantation (autoSLET); Immunofluorescence staining; Impression cytology; In vivo confocal microscopy (IVCM); Limbal stem cell deficiency (LSCD); Limbal stem cell transplantation; Living-related allogenic simple limbal epithelial transplantation (Lr-alloSLET).

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Corneal Diseases* / surgery
Epithelium, Corneal*
Humans
Limbus Corneae*
Middle Aged
Phenotype
Prospective Studies
Stem Cell Transplantation
Stem Cells
Transplantation, Autologous