Autologous Glueless Simple Limbal Epithelial Transplantation for Unilateral Stem Cell Deficiency Using Femtosecond Laser-Assisted Limbal Stem Cell Harvesting: The Report of the First 3 Clinical Cases

Cornea. 2025 Feb 21;44(8):1058-1069. doi: 10.1097/ICO.0000000000003838.

Abstract

Purpose: To evaluate the first clinical results of corneal surface reconstruction with the help of a femtosecond laser (FSL)-full FSL-assisted autologous glueless simple limbal epithelial transplantation (Full FSL G-SLET) for unilateral limbal stem cell deficiency.

Methods: After chemical eye burns, 3 patients underwent Full FSL G-SLET procedures, including 2 critical laser-assisted steps: harvesting of the 8 autologous limbal micrografts from the healthy eyes and placing them into laser-cut nonpenetrating corneal tunnels performed on the affected eye.

Results: The donor eyes recovered very quickly, and 3 to 4 weeks after surgery, a small scar in the limbal area formed with no adverse effects on visual acuity. Three patients had various rates of corneal reepithelization of the recipient eyes: 1 month, 1.5 months, and 4 months postoperatively. Complete corneal epithelialization was achieved in all cases. The epithelial layer was stable for 12 months postoperatively, as confirmed by corneal staining with low-molecular-weight fluorescein and anterior segment optical coherence tomography. Visual acuity improvement was observed in all 3 patients.

Conclusions: This is the first report of successful clinical use of FSL for autologous G-SLET surgical procedures when the laser was used not only to create corneal tunnels for autologous limbal micrograft fixation but also for their in vivo harvesting and fragmentation.

Keywords: anterior segment optical coherence tomography; corneal epithelial mapping; corneal tunnel; femtosecond laser; glueless simple limbal epithelial transplantation; limbal micrografts; limbal stem cell deficiency; ocular surface reconstruction; simple limbal epithelial transplantation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Burns, Chemical* / surgery
  • Corneal Diseases* / surgery
  • Epithelium, Corneal* / cytology
  • Epithelium, Corneal* / transplantation
  • Eye Burns* / chemically induced
  • Eye Burns* / surgery
  • Female
  • Humans
  • Laser Therapy* / methods
  • Limbal Stem Cells
  • Limbus Corneae* / cytology
  • Male
  • Middle Aged
  • Stem Cell Transplantation* / methods
  • Stem Cells* / pathology
  • Tissue and Organ Harvesting* / methods
  • Tomography, Optical Coherence
  • Transplantation, Autologous
  • Visual Acuity / physiology