Simple Limbal Epithelial Transplantation Using

Cryopreserved Amniotic Membrane for Unilateral Limbal Stem Cell

Deficiency: Follow-up DataID: 14739

Neda Nikpoor, MD; Marwan Atallah, MD; Anat Galor, MD, MSPH; Carol L. Karp, MD; Victor L. Perez, MD; Guillermo Amescua, MD

The authors have no financial disclosures relevant to the topic.

Purpose:• To report the results of modified simple limbal

epithelial transplantation (SLET) using cryo-preserved amniotic membranes (AMT) at our institution for the management of unilateral limbal stem cell deficiency (LSCD).

Methods:• 13 consecutive patients with unilateral partial (5 eyes) and total (8

eyes) LSCD secondary to ocular surface chemical/thermal burns (6 eyes), iatrogenic injury (2 eyes), sequelae of infectious keratitis (2 eyes), and autoimmune cicatrizing conjunctivitis (3 eyes – one mucous membrane pemphigoid, one sarcoidosis, one Stevens–Johnson syndrome), underwent modified SLET procedure.

• The patients were followed for a minimum of 4 months. The current mean (and median) follow up time was 11.8 months (+/-6.14).

• Pre- and post-operative BCVA and quality of corneal epithelium were evaluated.

• SLET was used in combination with PKP in 4 patients, simultaneously in 2 patients.

Results:• 11 patients had significant improvement in visual acuity. • Normal corneal epithelial architecture was achieved in all

patients but one. • Only one patient did not resorb the AMT by 2 months. • Four of 11 patients have completed one year follow up,

and the corneal epithelium and architecture has remained normal with no signs of LSCD.

• Four patients were treated with PK and SLET (either sequential SLET then PK or same day).

• To date there have been no complications in the donor eye.

Case Age Sex Eye Etiology of LSCD

Clock Hours of

InvolvementFollow up

(Mo)PRE SLET

BCVAPOST SLET

BCVA

1 35 M OS Chemical 6 18 HM 20/40

2 25 F OD Chemical 4 14 3/200 20/30

3 25 M OS chemical 8 9 20/300 20/20

5 75 F OD Iatrogenic - MMC 12 20 20/400 20/40

6 58 M OD Chemical 12 18 20/200 20/30

7 49 F OS Chemical <12 22 CF 1' 20/50

9 17 M OS Thermal/chemical 12 8 LP 20/400

4 79 M OS Infectious keratitis 7 11 HM CF 3'

8 42 F OS Infectious keratitis 12 4 HM 20/60

10 66 F OD SJS 12 8 HM HM

11 74 M OD Mucous membrane pemphigoid 12 7 HM CF 2'

12 69 M OD Sarcoid cicatricial conjunctivitis 12 12 HM 3/200

13 41 M OS Iatrogenic - multiple retina surgeries 12 3 2/200 HM

PLEASE NOTE THE FOLLOWING EXPLANATIONS:Case 4

Simultaneous PK/SLET done for insurance reasons. Unable to obtain follow up but patient reports good vision per telephone conversation.

Case 8 Simultaneous PK/SLET done for international patient, unable to travel for multiple surgery dates.Cases 10, 11, 12 Failed SLET. Failure likely attributable to autoimmune etiologyCase 13 Failed SLET. Failure likely attributable to cornea being completely neurotrophic.

Etiology of LSCD & Success vs Failure

Ocular

Surfa

ce Burn

s

Infectious K

eratitis S

equelae

Autoim

mune Cicatri

zing D

isease

Iatro

genic

0123456

6

2 311

FailedSuccessful

Top: SLET, extensive pannusMiddle: SLET + MMGBottom: SLET + PKP

Select Pre- and Post-Operative Photos

Conclusions:• SLET appears to be a safe, reproducible and effective alternative for

the surgical management of LSCD. • In our hands, patients with autoimmune etiologies of LSCD have not

yet had successful outcomes. More data is to be collected, but it appears that an autoimmune etiology or neurotrophic cornea are predictors of failure.

• Excluding the 4 autoimmune and neurotrophic patients, the results are overwhelmingly positive with no known complications in donor eye, healthy ocular surface and dramatic improvement in BCVA, and as long as 22 months of follow up to date.

• SLET may also be used to improve the prognosis of penetrating keratoplasty in patients with severe LSCD who were previously poor candidates for corneal transplantation. We recommend the sequential procedure.