title: Simple Limbal Epithelial Transplantation: Long-Term Clinical Outcomes in 125 Cases of Unilateral Chronic Ocular Surface Burns.
abstract: This study describes the long-term clinical outcomes of autologous simple limbal epithelial transplantation (SLET), a relatively new technique of limbal stem cell transplantation.
  
  
  
  This was a single-center prospective interventional cases series.
  
  
  
  This study included 125 patients, 65 adults and 60 children who developed unilateral limbal stem cell deficiency (LSCD) after suffering with ocular surface burns and underwent SLET between 2010 and 2014.
  
  
  
  A 1-clock hour limbal biopsy sample was obtained from the unaffected eye. At the same sitting, the recipient eye was surgically prepared and the donor tissue was divided into small pieces and transplanted using an amniotic membrane scaffold with fibrin glue.
  
  
  
  The diagnosis and outcome in every case was validated by 5 independent masked assessors. The primary outcome measure was restoration of a completely epithelized, stable, and avascular corneal surface. The secondary outcome measure was improvement in visual acuity. Complications, risk factors for failure, and immunohistochemistry analysis of corneas that underwent SLET also were described.
  
  
  
  At a median postoperative follow-up of 1.5 years (range, 1-4 years), 95 of 125 eyes (76%; 95% confidence interval, 68.5%-83.5%) maintained a successful outcome. Kaplan-Meier analysis revealed a comparable survival probability at 1 year of 80% in adults and 72% in children (P = 0.304). Two-line improvement in visual acuity was seen in 75.2%, and 67% of successful cases attained 20/60 or better vision (P < 0.0001). Progressive conjunctivalization occurred in 18.4% of eyes. The clinical factors associated with failure were identified as acid injury, severe symblepharon, SLET combined with keratoplasty, and postoperative loss of transplants (P ≤ 0.0075). Success rates were comparable among faculty and trainees (P = 0.71). Immunohistochemistry revealed successful regeneration of normal corneal epithelium (CK3(+)/12(+)) without admixture of conjunctiva cells (Muc5AC(-)/CK19(-)) and replenishment of limbal stem cell (ΔNp63α(+)/ABCG2(+)) reserve.
  
  
  
  Autologous SLET is an effective, reliable and replicable technique for long-lasting corneal regeneration and vision restoration in unilateral chronic ocular surface burns. Simple limbal epithelial transplantation is probably preferable to other techniques of limbal stem cell transplantation, particularly where cell cultivation facilities are unavailable.
authors.affiliation: Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India; Center for Regenerative Ophthalmology, L. V. Prasad Eye Institute, Hyderabad, India; Prof. Brien Holden Eye Research Center, Champalimaud Translational Centre for Eye Research, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Sayan
authors.initials: S
authors.lastname: Basu
authors.affiliation: Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Shraddha P
authors.initials: SP
authors.lastname: Sureka
authors.affiliation: Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Swapna S
authors.initials: SS
authors.lastname: Shanbhag
authors.affiliation: Center for Regenerative Ophthalmology, L. V. Prasad Eye Institute, Hyderabad, India; Prof. Brien Holden Eye Research Center, Champalimaud Translational Centre for Eye Research, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Abhinav R
authors.initials: AR
authors.lastname: Kethiri
authors.affiliation: Center for Regenerative Ophthalmology, L. V. Prasad Eye Institute, Hyderabad, India; Prof. Brien Holden Eye Research Center, Champalimaud Translational Centre for Eye Research, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Singh
authors.affiliation: Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India; Center for Regenerative Ophthalmology, L. V. Prasad Eye Institute, Hyderabad, India; Prof. Brien Holden Eye Research Center, Champalimaud Translational Centre for Eye Research, L. V. Prasad Eye Institute, Hyderabad, India. Electronic address: vsangwan@lvpei.org.
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000293:Adolescent; D000328:Adult; D002057:Burns, Chemical / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002908:Chronic Disease; D004847:Epithelial Cells / Q000637:transplantation*; D019573:Epithelium, Corneal / Q000502:physiology; D005126:Eye Burns / Q000139:chemically induced* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis; D006801:Humans; D016850:Limbus Corneae / Q000166:cytology*; D008297:Male; D011446:Prospective Studies; D012038:Regeneration / Q000502:physiology; D012307:Risk Factors; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult