Allogenic simple limbal epithelial transplantation beneficial in severe chemical injuries
Allogenic simple limbal epithelial transplantation leads to faster healing and better visual outcomes as compared with amniotic membrane grafting alone in eyes with severe chemical injuries of grade 4 or worse, according to a study.
While amniotic membrane grafting (AMG) alone has been shown to be beneficial in injured eyes with an adequate amount of residual cells, an external cell source might be needed to populate the graft in case of more severe cell-depleting chemical trauma. With allogenic simple limbal epithelial transplantation (alloSLET), the amniotic membrane is supplemented with small parts of limbal donor tissue, secured on the corneal periphery with fibrin glue.
In the study, 38 eyes of 36 patients underwent AMG and 39 eyes of 37 patients underwent alloSLET. All patients had grade 4 or worse chemical injury, based on Dua classification, caused by calcium oxide or acid, and many of them were young, a median of 11 years in the AMG group and 8 years in the alloSLET group.
The eyes treated with alloSLET showed statistically significant faster epithelialization, within 41 days on average, as compared with 75 days in the AMG group. Faster epithelialization resulted in less frequent and less severe symblepharon and lesser corneal scarring, reducing the need for multiple surgeries to address these issues.
Half of the eyes developed grade 4 symblepharon in the AMG group compared with 3.7% in the alloSLET group. Leukomatous scarring occurred in 28% of eyes in the alloSLET group vs. 58% in the AMG group. Despite the treatment, 92% of the eyes in the AMG group developed total limbal stem cell deficiency as compared with 61.5% in the alloSLET group. Final best corrected visual acuity greater than 20/200 was achieved in 39.4% of AMG eyes and 53.8% of alloSLET eyes.
According to the authors, this study “clearly highlights the advantages of alloSLET over AMG in the severe grades of chemical injury with very limited residual cells, conjunctival and corneal.”
“AlloSLET should be added to the armamentarium of modalities in the management of acute severe-grade chemical injuries,” they wrote.