Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India.
Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India.
Br J Ophthalmol. 2018 Dec;102(12):1640-1645. doi: 10.1136/bjophthalmol-2017-311506. Epub 2018 Feb 16.
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.
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.
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.
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.
培养的角膜缘上皮移植（CLET）在约 20％-30％的病例中失败。本研究旨在报告自体简单角膜缘上皮移植（SLET）在因 CLET 失败而导致复发性单侧角膜缘干细胞缺陷（LSCD）的眼中的临床结果。
这是一项前瞻性病例系列研究，纳入了 2010 年至 2016 年间因 24 例（n=24）或 6 例（n=6）先前 CLET 手术失败而接受 SLET 的 30 例患者的 30 只眼。主要观察指标是根据 5 项客观标准（最佳矫正视力（BCVA）和结角膜粘连、角膜结膜化、血管化和混浊的等级）的相对改善情况来定义 SLET 的成功。
平均随访 2.3 年后，30 只眼中有 24 只（80％）保持成功的结果。Kaplan-Meier 分析显示 5 年生存率为 77％±8％。术后 1 年，BCVA（3 至 1 对数最小角分辨率）和角膜结膜化（2 至 0）、血管化（2 至 0）和混浊（2 至 1）的中位数等级均有统计学显著改善（P≤0.0026）。在 62.5％的成功病例中，BCVA 提高到 20/200 或更好。在 CLET 失败后再次行 SLET 的成功率（53.5％）优于重复 CLET（P=0.011）。供体眼中均未发生任何并发症。
在先前 CLET 失败后出现 LSCD 复发的眼中，SLET 是 CLET 的有效替代方法。由于 SLET 是单阶段且成本较低，因此可能优于重复 CLET。
