Malyugin Boris, Svetlana Kalinnikova, Fabian Muller, Werner Bernau, Boris Knyazer, Maksim Gerasimov
S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia.
Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Cornea. 2025 Feb 1;44(2):262-270. doi: 10.1097/ICO.0000000000003688. Epub 2024 Aug 27.
Surgical treatment of unilateral limbal stem cell deficiency (LSCD) is based on limbal stem cell transplantation. Glueless simple limbal epithelial transplantation (G-SLET) technique implements several limbal micrografts harvested from the healthy eye of the same patient into the peripheral corneal tunnels without the use of fibrin glue and human amniotic membrane.
A novel customized algorithm and software for a low-energy femtosecond laser (FSL) were developed and tested using 5 pairs of isolated porcine eyes. FSL-assisted G-SLET modification was assessed in 3 clinical cases of unilateral LSCD caused by chemical burns. Corneal epithelization efficacy, best-corrected visual acuity, corneal epithelial mapping, central corneal thickness, and impression cytology with immunohistochemical examination were evaluated. All patients were followed up for 12 months postoperatively.
The FSL set for 100% energy and the pattern of 8 nonpenetrating vertical cuts with oblique tunnel portions having variable incision depths and diameter of 8.5 mm and higher were selected for further clinical evaluation. Clinically, stable corneal epithelialization was achieved 2 to 3 weeks after intervention. At the 6-month follow-up, all patients had a healthy corneal epithelium with limbal micrografts visible inside the corneal tunnels. Best-corrected visual acuity markedly improved in 2 cases, but not in the third case with severe corneal stromal scarring. In addition, all patients noted a full-scale reduction in subjective complaints and substantial improvement in their quality of life.
The FSL-assisted G-SLET is a new technique for autologous limbal stem cell transplantation in patients with unilateral LSCD. It allows the standardization of corneal tunnel localization and dimensions, thereby increasing the safety of the surgical procedure.
单侧角膜缘干细胞缺乏（LSCD）的手术治疗基于角膜缘干细胞移植。无胶水单纯角膜缘上皮移植（G-SLET）技术是将从同一名患者健康眼采集的多个角膜缘微小移植物植入周边角膜隧道，无需使用纤维蛋白胶和人羊膜。
开发了一种用于低能量飞秒激光（FSL）的新型定制算法和软件，并使用5对离体猪眼进行测试。在3例因化学烧伤导致的单侧LSCD临床病例中评估了FSL辅助的G-SLET改良术。评估了角膜上皮化效果、最佳矫正视力、角膜上皮地形图、中央角膜厚度以及免疫组织化学检查的印片细胞学。所有患者术后随访12个月。
选择能量设置为100%、8条非穿透性垂直切口且斜向隧道部分具有可变切口深度、直径为8.5毫米及以上的模式进行进一步临床评估。临床上，干预后2至3周实现了稳定的角膜上皮化。在6个月随访时，所有患者角膜上皮健康，角膜隧道内可见角膜缘微小移植物。2例患者的最佳矫正视力显著提高，但第3例伴有严重角膜基质瘢痕的患者视力未改善。此外，所有患者均表示主观症状全面减轻，生活质量大幅提高。
FSL辅助的G-SLET是单侧LSCD患者自体角膜缘干细胞移植的新技术。它使角膜隧道定位和尺寸标准化，从而提高了手术的安全性。
