Allogenic simple limbal epithelial transplantation (alloSLET) from cadaveric donor eyes in patients with persistent corneal epithelial defects

Abstract

Background/aimTo describe the clinical outcome of allogenic simple limbal epithelial transplantation (alloSLET) utilising tissue from cadaveric donor eyes after failed re-epithelialisation of the corneal surface.MethodsMedical records of 14 eyes from 14 patients treated for persistent corneal epithelial defects with alloSLET were reviewed. The primary outcome measure was complete epithelialisation of the corneal surface. Secondary outcome measures were best corrected visual acuity (BCVA) and postoperative side effects due to surgery or medical therapy.ResultsOf the 14 eyes, 7 received alloSLET only and 7 alloSLET together with penetrating keratoplasty (PK). Thirteen (92.9%) of 14 eyes had an epithelialised corneal surface 3 and 6 months after surgery and 10 (71.4%) of 14 eyes displayed an epithelialised corneal surface 12 months after surgery. In both subgroups, alloSLET only and alloSLET with PK, respectively, 5 (71.4%) of 7 eyes had a stable corneal epithelium 12 months after surgery, respectively. Postoperatively, BCVA improved markedly in the whole patient collective. However, the increase was not significant when looking at the two individual subgroups. One patient lost his bandage contact lens several times within the first postoperative month and had a partial detachment of the amniotic membrane. The ocular surface of this patient failed to epithelialise. In three patients, limbal donor pieces translocated to the centre of the cornea, which possibly prolonged the improvement of BCVA.ConclusionAlloSLET appears to be an effective treatment option in eyes with non-healing corneal epithelial defects when autologous limbal tissue is not available.

Recent advances in cell-based regenerative therapies for corneal disease

“…Survival rates of rejection-free and PED-free grafts were 75.0% and 42.3% at 24 months. Riedl et al [9 ▪ ] compared allogeneic SLET to a combined simultaneous allogeneic SLET and PKP in 14 patients. The overall graft failure rate was 28.6% with PED being the main cause, while no difference was found between groups and no rejections were reported.…”

Corneal Epithelial Regeneration: Old and New Perspectives

“…Results from a multicenter study indicate that autologous SLET is an effective and safe modality for the treatment of unilateral LSCD, where 57 of 68 eyes that received auto-SLET (83.8%) reached the main outcome of a complete restoration of the corneal epithelium [ 58 ], with a similar success rate and visual acuity improvement to those reported with CLET. Allo-SLET represents a valid option for bilateral LSCD such as persistent epithelial defects [ 59 ] and iatrogenic LSCD [ 60 ]; however, it requires indefinite use of systemic and topical immunosuppressants [ 61 ]. A recent retrospective case series compared the outcome of patients treated with amniotic membrane alone vs. AMT + allo-SLET, highlighting the superior outcomes of the latter method in terms of time of recovery and rate of side effects [ 62 ].…”

BCLA CLEAR – Medical use of contact lenses

“…In a small case series examining the use of a topical regenerative agent and a BSCL for the treatment of PEDs, all eyes and PEDs fully healed within three weeks with said treatment [142]. Large diameter BSCLs have also been used following allogenic simple limbal epithelial transplantation for the treatment of PEDs with successful re-epithelialisation in 93 % of eyes [143]. In this case series, all patients wore BSCLs, thus no control group was included.…”