Femtosecond Laser-Assisted Simple Limbal Epithelial Transplantation (Femto-Slet) In A Treatment Of Unilateral Limbal Stem Cell Deficiency.

To assess the use of a femtosecond laser for limbal stem cell transplantation in a patient with unilateral limbal stem cell deficiency syndrome (LSCD).

The S. Fyodorov Eye Microsurgery Federal State Institution

A 29-year-old patient with unilateral LSCD following a chemical burn of the eye was indicated for surgical treatment to restore the corneal epithelial layer using simple limbal epithelium transplantation (SLET). To achieve a stable epithelial layer of the cornea and the most effective SLET, it is advisable to form a limbal graft, capturing all the structures of the limbal niche, which in addition to limbal epithelial stem cells includes mesenchymal cells, melanocytes, immune cells, vascular and nerve cells, extracellular matrix,growth factors and cytokines. All these components play a significant role in the proliferation of limbal stem cells. For the first time documented, a low-energy femtosecond laser (Femto LDV Z8, Ziemer Ophthalmic Systems, Switzerland) was used to form the limbal micro-transplants instead of the standard manual technique. Thanks to the built-in OCT, using a low energy level, cutting out the limbal graft is possible precisely according to the specified parameters. As a result of the operation of the femtosecond laser, 8 mini-grafts were formed. All obtained micro-transplants were easily separated from the limbus and placed in pockets also formed by a femtosecond laser on the periphery of the corneal stroma of the affected eye according to the glueless-SLET technology. No tissue bridges were found between the micro-transplants and the underlying tissues. After one month of observation, the corneal epithelium of the affected eye remained stable.

Improvement of SLET technology using a femtosecond laser is a promising direction in treatment of unilateral LSCD.