Clinical efficacy of autologous simple Limbal epithelial transplantation for stem cell deficiency in ocular surface burn

Abstract Purpose: To describe long term clinical outcome of simple Limbal epithelial transplantation(SLET). Design: Single center prospective interventional case series. Participants: This study include 21 patients, 12 adults and 9 children, who developed unilateral Limbal stem cell deficiency (LSCD) after ocular surface burn and underwent SLET between 2019 and 2021. Method: A 3.5 mm to 4 mm Limbal biopsy sample was harvested from unaffected eye. The recipient eye was surgically prepared and the autologous donor tissue was divided into small pieces and transplanted in mid periphery of the recipient cornea 360 around, using amniotic membrane, sutured with 10/0 nylon. Results: The study Includes of 21 patients, 12 adults and 9 children, with unilateral LSCD suffering from 0cular surface burn. Total LSCD (12 Clock hours) was seen in the affected eye in 11(91.66%) adults and 6 (66.66%) children and partial LSCD (less than 6 Clock hours) was seen 1(8.33%) adult and 3 (33.33%) children. Males were more common among adults, 7(58.33%) than children 5 (55.55%; p=.098) and adult female,5(41.66%) than female children, 4(44.44%). Accidental pressure cooker blast,3(33.33%) and lime burn,2(22.22%) were the most common causes of LSCD in children, whereas in adults causes include industrial alkali,4(33.33%) and lime burn, 3(33.33%). At the final follow up visit after SLET, 18 of 21 eyes in adults (91.66%) and children (77.77%) maintained a successfully regenerated stable corneal surface. Among patients with total LSCD, successful outcome was observed in 90% adults and 83% children and with partial LSCD success rate was 92% in adults and 83% in children respectively. There was a significant improvement in best corrected visual acuity (BCVA) after SLET compared with the base line in all age groups. In group 1, 14(66.66%) patients had pre-operative visual acuity of hand moment or perception of light with 0% visual acuity postoperatively. In group 2 ,07(33.33%) and 04(19.04%) patients had BCVA between 1/60 to 6/60, pre-operative and post-operative respectively. In group 3, none of the patient had pre-operative VA better than 6/60. Seventeen (80.95%) patients had recovered BCVA better than 6/60 with 95% Confidence interval and p value 0.000. Conclusion: 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.