Early Results of Penetrating Keratoplasty in Patients With Unilateral Chemical Injury After Simple Limbal Epithelial Transplantation

Gupta, Nidhi; Farooqui, Javed Hussain; Patel, Nikunj V; Mathur, Umang

doi:10.1097/ico.0000000000001681

Cited by 32 publications

(18 citation statements)

References 23 publications

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“…Similar BCVA results (mean follow-up of 4.8 years) have been achieved for allogeneic cultivated limbal epithelial transplantation with or without subsequent penetrating keratoplasty [97]. Encouraging results have also been reported in a small study looking at the early outcomes for penetrating keratoplasty following SLET [98]. A recently published study looked at the outcome of PKP in 14 patients who previously underwent COMET [95].…”

Section: Management Of Chronic Complicationssupporting

confidence: 54%

An update on chemical eye burns

Bizrah

Yusuf²,

Ahmad

2019

Eye

106

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Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as key challenges. Education and prevention are therefore important public health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherence rates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.

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Section: Management Of Chronic Complicationssupporting

confidence: 54%

An update on chemical eye burns

Bizrah

Yusuf²,

Ahmad

2019

Eye

106

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“…4e). Short-term results in a group of seven patients (mean follow-up of 15 months) show that most PKPs survive; however, it is not clear what visual improvement, if any, PKP offered in this cohort, and many of the patients had poor visual acuity at final follow-up [65].…”

Section: Simple Limbal Epithelial Transplant (Slet)mentioning

confidence: 83%

“…For a review of the specific complications of these procedures see Yin et al [64]. Penetrating keratoplasty (PKP) is frequently undertaken as a second procedure following LSC transplantation in order to replace deep scarred stroma, with the ultimate aim of restoring sight [65][66][67].…”

Section: Tissue Transplant Techniques: Conjunctival-limbal and Keratomentioning

confidence: 99%

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

2020

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Destruction of the limbus and depletion of limbal stem cells (LSCs), the adult progenitors of the corneal epithelium, leads to limbal stem cell deficiency (LSCD). LSCD is a rare, progressive ocular surface disorder which results in conjunctivalisation and neovascularisation of the corneal surface. Many strategies have been used in the treatment of LSCD, the common goal of which is to regenerate a self-renewing, transparent, and uniform epithelium on the corneal surface. The development of these techniques has frequently resulted from collaboration between stem cell translational scientists and ophthalmologists. Direct transplantation of autologous or allogeneic limbal tissue from a healthy donor eye is regarded by many as the technique of choice. Expansion of harvested LSCs in vitro allows smaller biopsies to be taken from the donor eye and is considered safer and more acceptable to patients. This technique may be utilised in unilateral cases (autologous) or bilateral cases (living related donor). Recently developed, simple limbal epithelial transplant (SLET) can be performed with equally small biopsies but does not require in vitro cell culture facilities. In the case of bilateral LSCD, where autologous limbal tissue is not available, autologous oral mucosa epithelium can be expanded in vitro and transplanted to the diseased eye. Data on long-term outcomes (over 5 years of follow-up) for many of these procedures is needed, and it remains unclear how they produce a self-renewing epithelium without recreating the vital stem cell niche. Bioengineering techniques offer the ability to recreate the physical characteristics of the stem cell niche, while induced pluripotent stem cells offer an unlimited supply of autologous LSCs. In vivo confocal microscopy and anterior segment OCT will complement impression cytology in the diagnosis, staging, and follow-up of LSCD. In this review we analyse recent advances in the pathology, diagnosis, and treatment of LSCD.

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“…The outcomes of sequential secondary surgeries such as PK and deep anterior lamellar keratoplasty (DALK) after SLET were also reported. [2526] In seven eyes of seven patients who underwent PK 9.5 ± 11.9 months after SLET, six eyes maintained a clear graft at 15.1 ± 5.4 months after PK. [25] Another report of 11 eyes of children who underwent DALK following SLET for unilateral severe chemical injury with LSCD with follow-up of 13 ± 4.6 months following DALK reported anatomical success in 8 (72%) eyes and visual acuity improvement in six (54%) eyes.…”

Section: Clinical Efficacymentioning

confidence: 99%

“…[10] Since then, SLET has become the preferred technique of LSCT. [11121314151617181920212223242526272829] In this review, the authors enumerate the indications, surgical technique, mechanism of action, outcomes, limitations, and impact of SLET on patients with blinding LSCD.…”

mentioning

confidence: 99%

Simple limbal epithelial transplantation (SLET): Review of indications, surgical technique, mechanism, outcomes, limitations, and impact

Shanbhag

Patel²,

Goyal³

et al. 2019

Indian J Ophthalmol

101

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Simple limbal epithelial transplantation (SLET) is an innovative limbal stem cell transplantation technique that has gained increasing popularity over the last few years. Different groups from across the world have published the clinical results of SLET in large case series with varying types and severities of limbal stem cell deficiency (LSCD). This review attempts to place all the available knowledge on SLET together in one place for the benefit of not only cornea specialists and trainees but also for residents and general ophthalmologists. It follows a balanced approach of blending evidence with experience by providing an objective analysis of published results along with helpful insights from subject experts, starting from preoperative considerations including the role of newer imaging modalities to the technical aspects of the surgery itself and the management of possible complications. Original data and novel insights on allogeneic SLET for bilateral LSCD are included in the review to address the few remaining lacunae in the existing literature on this topic. This review intends to inform, educate, and empower all aspiring and practicing SLET surgeons to optimize their clinical outcomes and to have maximal positive impact on the lives of the individuals affected by unilateral or bilateral chronic LSCD.

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Early Results of Penetrating Keratoplasty in Patients With Unilateral Chemical Injury After Simple Limbal Epithelial Transplantation

Abstract: PKP was found to have a good outcome when the surface has been stabilized by SLET as an initial procedure in unilateral ocular chemical injury. The visual outcome was restricted mainly by other causes such as glaucoma and amblyopia.

Cited by 32 publications

References 23 publications

An update on chemical eye burns

An update on chemical eye burns

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

Simple limbal epithelial transplantation (SLET): Review of indications, surgical technique, mechanism, outcomes, limitations, and impact

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