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Simple limbal epithelial transplantation (SLET) is used to treat unilateral limbal stem cell deficiency (LSCD). It involves harvesting healthy limbal stem cells from a healthy eye for autologous implantation into the diseased eye to restore corneal transparency and prevent conjunctivalization. This activity describes the evaluation and etiology of LSCD and highlights the role of the interprofessional team in evaluating and treating patients who undergo SLET surgery and its complications. Objectives: Review the LSCD disease process and theory behind simple limbal epithelial transplantation (SLET). Describe simple limbal epithelial transplantation (SLET) and compare it with other LSCD treatments. Identify common complications of simple limbal epithelial transplantation (SLET) and how to manage them. Explain the importance of communication among the health team workers for the appropriate selection of candidates for simple limbal epithelial transplantation (SLET) and improvement of postoperative management. Access free multiple choice questions on this topic.

Sangwan et al. first described simple limbal epithelial transplantation (SLET) in 2012; it is a procedure for unilateral limbal stem cell deficiency (LSCD) treatment to restore normal corneal epithelium. SLET involves sectorial harvesting of the limbus from the patient’s healthy contralateral eye to be sectioned into 8-12 smaller limbal autografts. After the removal of any abnormal corneal epithelium and fibrovascular pannus from the diseased eye, an amniotic membrane is placed on the cornea, and the limbal autografts are transplanted onto the membrane followed by a bandage cornea lens.[1][2][3] The amniotic membrane is used because it contains growth factors and possesses antiangiogenic, anti-inflammatory, antimicrobial, and anti-scarring properties that promote the expansion of stem cells and migration of epithelial cells before inflammation and scarring can curtail regeneration.[4] Allogenic SLET Allogeneic SLET is similar to autologous SLET except that it uses limbal grafts from cadavers or living donors and may be used to treat bilateral LSCD. Current data has not found a significant difference in outcomes after the use of tissue from either living or cadaveric donors. Allogenic SLET has also been used to achieve rapid surface epithelialization in acute chemical burns.[5] Patients with allografts from any source require postoperative intravenous immunosuppression followed by long-term systemic immunosuppression, most often cyclosporine, and topical steroid drops to ensure graft survival.[6] When compared to autologous SLET, allogenic SLET has the downside of requiring immunosuppression. Still, it is a treatment for patients who cannot undergo autologous SLET due to bilateral LSCD from a systemic etiology or injury to both eyes.[7][8]

Significant risk factors associated with simple limbal epithelial transplantation (SLET) failure include the following: Chemical burns Symblepharon presence before surgery and simultaneous SLET Penetrating keratoplasty. Failure most often occurs within six months after surgery. Significant complications in the donor eye have not been observed. The most common complication seen in the treated eye is focally recurrent LSCD. If the recurrent LSCD is not progressing or affecting the visual axis, it may be monitored, and repeat SLET has successfully treated recurrent LSCD. Hemorrhage under the amniotic membrane may occur, but often resolves or only requires drainage via a needle puncture. Sterile or infectious keratitis may develop and has been described to respond well to treatment and topical antibiotics. If superficial corneal haze is present, topical cyclosporine 0.05% drops are prescribed for several months. Complications that may cause graft failure include progressive conjunctivalization, symblepharon, and loss of donor tissue attached to the bandage contact lens. Rare complications include corneal neovascularization, epithelial hyperplasia, and PED.  Allogenic SLET will have a risk of immunologic rejection that may be treated with an increased dose of intravenous and oral Immunosuppressants.[7][25]

Simple limbal epithelial transplantation (SLET) is an effective treatment for unilateral LSCD. Clear communication with the patient or referring provider is essential to establish the underlying cause of LSCD. SLET is also a more affordable and less complicated alternative to CLET, so it may prove to be the ideal treatment for patients in areas with inadequate resources. SLET utilizes an autologous transplant and does not require immunosuppression; however, allogenic SLET will require coordinated care among the health care team to monitor and treat any adverse reactions from immunosuppression.