We read with interest the article by Kaliki and associates1 about performing concomitant simple limbal epithelial transplantation (SLET) after surgical excision of ocular surface squamous neoplasia (OSSN), along with its recent correspondence by Chan and associates.2
We agree with Chan and associates that the current evidence is not sufficient to support concomitant primary SLET in most cases of OSSN. In fact, we do not support the idea of any type of limbal surgical transplantation, such as conjunctival-limbal autografting or ex vivo–cultivated limbal epithelial transplantation, as a prevention of limbal stem cell deficiency (LSCD) after wide excisional surgery.
OSSN has been reported after a living-related conjunctival limbal allograft3 and we had a case of OSSN after autologous ex vivo–cultivated limbal epithelial transplantation. Our case involved an 80-year-old woman with a history of neurotrophic ulcer refractory to medical and surgical treatment with amniotic membrane transplantation.
After the subject was diagnosed with LSCD, a 2 × 2-mm limbal biopsy of the healthy eye was cultivated with our animal-free and no-feeder-cell technique4 in a Good Manufacturing Practice facility and then transplanted to the fellow eye. Two years later, OSSN was diagnosed and treated with surgical excision, cryotherapy, and amniotic membrane transplantation. This patient did not develop LSCD after OSSN surgery for at least 1 year of follow-up.
Although primary OSSN after limbal transplantation seems to be anecdotal, there is an overall higher incidence of primary cancer in recipients of other organs.5 Kaliki and associates found that concomitant SLET after surgical excision has higher success rates compared with those who undergo SLET as a secondary procedure after development of LSCD. We believe that surgical treatment of LSCD must be justified by prior LSCD diagnosis, because OSSN can develop after limbal stem cell transplantation.
CITATION Am J Ophthalmol. 2017 May 4. pii: S0002-9394(17)30175-7. doi: 10.1016/j.ajo.2017.04.015