Kellogg Offers Multiple
Options for Limbal
Stem Cell Deficiency
The corneal epithelial cells that protect the surface of the eye
are continuously shed throughout the day. If these cells are
not replenished, the health and clarity of the cornea -and
the vision -are threatened.
The only cells capable of generating replacement
epithelial cells are limbal stem cells, located between the
cornea and the sclera. Circumstances that can lead to the
loss of limbal stem cells or limbal stem cell deficiency (LSCD)
include genetic diseases such as aniridia, inflammatory
conditions such as Stevens-Johnson syndrome, or trauma
to the cornea from a thermal or chemical burn.
Limbal stem cell transplantation is the only intervention
to counteract LCD. “But each patient’s situation is unique, and
there is more than one transplant strategy to consider,” explains
Kellogg corneal transplant surgeon Shahzad Mian, M.D.
“Kellogg has one of the few programs in the region
able to offer multiple transplant options to
protect the long-term vision of patients
with LSCD.”
When LCD affects both eyes, the
established treatment is a keratolimbal
allograft, or KLAL graft – the trans-
plantation of limbal tissue from
a deceased donor into each eye.
Recipients must tolerate extended
systemic immunosuppression
therapy following transplantation.
Although KLAL has been available
for decades, only high volume corneal
transplant centers like Kellogg have the
surgical expertise to perform it.
For patients with bilateral LCD who
are not good candidates for allograft transplan-
tation, the best option may be keratoprosthesis, a
synthetic corneal transplant. For nearly 20 years, Kellogg has
been the only center in Michigan to offer this treatment option,
which does not require post-transplant systemic immunosup-
pression.
When only one eye has LCSD, it is possible to transplant
corneal limbal stem cells from the patient’s unaffected eye, a
procedure called simple limbal epithelial transplantation, or
SLET. “The main advantage of SLET is that it requires only
Shahzad Mian, M.D., and Nambi Nallasamy, M.D., review tissue samples
KELLOGG HAS ONE OF THE FEW
PROGRAMS IN THE REGION ABLE TO
OFFER MULTIPLE TRANSPLANT OPTIONS
TO PROTECT THE LONG-TERM VISION
OF PATIENTS WITH LSCD.
– Shahzad Mian, M.D.
a small number of the patient’s own cells,” explains Kellogg
corneal transplant surgeon Nambi Nallasamy, M.D. «The
impact on the unaffected eye is negligible, and systemic
immunosuppression is not needed.»
While SLET is proven to be safe and
effective, the procedure is not performed
as often in the U.S. as it is in other
countries. Outside the U.S., instances
of LCD impacting one eye tend to
arise from chemical injuries or ac-
cidents, which are far less prevalent
in the US.
Recognizing the significant
potential of SLET, Drs. Mian and
Nallasamy are at the forefront of
exploring next-generation applica-
tions for the procedure. In particular,
they are pursuing allogeneic SLET-
transplanting limbal stem cells from either
deceased or living-related donors.
“We are undertaking research with our
eye bank partner Eversight to determine an
effective protocol to obtain limbal stem cells from deceased
donors and prepare them for transplantation,” says Dr. Mian.
This may decrease the immunosuppressive burden on patients
treated for bilateral LCD. The introduction of deceased and
living-donor SET will further expand the options available to
treat patients with LCD at Kellogg. Dr. Nallasamy performed
the first living-related SET surgery at Kellogg in November