Download Simple Limbal Epithelial Transplantation Using Cryopreserved

Simple Limbal Epithelial
Transplantation Using
Cryopreserved Amniotic Membrane
for Unilateral Limbal Stem Cell
Deficiency: Follow-up Data
ID: 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 cryopreserved 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
Involvement
Follow up
(Mo)
PRE SLET
BCVA
POST 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:
Simultaneous PK/SLET done for insurance reasons. Unable to obtain follow up but patient reports
Case 4
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 etiology
Case 13
Failed SLET. Failure likely attributable to cornea being completely neurotrophic.
Etiology of LSCD & Success vs Failure
6
5
4
3
6
Failed
Successful
2
1
2
1
3
1
0
Ocular Surface
Burns
Infectious
Keratitis
Sequelae
Autoimmune
Cicatrizing
Disease
Iatrogenic
Top: SLET, extensive
pannus
Middle: SLET + MMG
Bottom: 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.