Autologous transplantation of conjunctiva by modifying simple limbal epithelial transplantation for limbal stem cell deficiency

  • Tohru Sakimoto
  • Akira Sakimoto
  • Satoru YamagamiEmail author
Clinical Investigation



As a treatment to replace regenerative medicine to treat limbal stem cell deficiency (LSCD), we performed 4 consecutive cases of autologous transplantation of conjunctival explants by modifying simple limbal epithelial transplantation (SLET).

Study design

Single-center case series.


Four patients with LSCD were enrolled in this study. After resection of scar tissue with neovascularization from the ocular surface, human amniotic membrane (AM) was placed over the bare ocular surface. The bulbar conjunctiva of the operated eye was dissected at the temporal superior fornix, divided into small pieces, and transplanted onto AM with fibrin glue. Keratoplasty was performed simultaneously or few months after surgery.


Epithelialization was achieved in all patients. Best-corrected visual acuity was improved in all patients.


This is the first report of ocular surface reconstruction using autologous conjunctival epithelial transplants from the affected eye. Transplantation by modifying SLET effectively restored a clear corneal surface with minimal neovascularization in 4 patients with LSCD. Autologous conjunctival transplants combined with AM transplantation could be a practical option for treating bilateral LSCD in patients without symblepharon or severe keratinization.


Conjunctival transplantation Limbal stem cell deficiency Simple limbal epithelial transplantation 



The authors indicate no funding support.

Conflicts of interest

T Sakimoto, None; A. Sakimoto, None; S. Yamagami, None.


  1. 1.
    Liang L, Sheha H, Li J, Tseng SC. Limbal stem cell transplantation: new progresses and challenges. Eye. 2009;23:1946–53.CrossRefGoogle Scholar
  2. 2.
    Koizumi N, Inatomi T, Suzuki T, Sotozono C, Kinoshita S. Cultivated corneal epithelial stem cell transplantation in ocular surface disorders. Ophthalmology. 2001;108:1569–74.CrossRefGoogle Scholar
  3. 3.
    Nishida K, Yamato M, Hayashida Y, Watanabe K, Yamamoto K, Adachi E, et al. Corneal reconstruction with tissue-engineered cell sheets composed of autologous oral mucosal epithelium. N Engl J Med. 2004;351:1187–96.CrossRefGoogle Scholar
  4. 4.
    Sangwan VS, Basu S, MacNeil S, Balasubramanian D. Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency. Br J Ophthalmol. 2012;96:931–4.CrossRefGoogle Scholar
  5. 5.
    Basu S, Sureka SP, Shanbhag SS, Kethiri AR, Singh V, Sangwan VS. Simple limbal epithelial transplantation: long-term clinical outcomes in 125 cases of unilateral chronic ocular surface burns. Ophthalmology. 2016;123:1000–10.CrossRefGoogle Scholar
  6. 6.
    Borroni D, Wowra B, Romano V, Boyadzhieva M, Ponzin D, Ferrari S, et al. Simple limbal epithelial transplantation: a review on current approach and future directions. Surv Ophthalmol. 2018;63:869–74.CrossRefGoogle Scholar
  7. 7.
    Tanioka H, Kawasaki S, Yamasaki K, Ang LP, Koizumi N, Nakamura T, et al. Establishment of a cultivated human conjunctival epithelium as an alternative tissue source for autologous corneal epithelial transplantation. Investig Ophthalmol Vis Sci. 2006;47:3820–7.CrossRefGoogle Scholar
  8. 8.
    Ono K, Yokoo S, Mimura T, Usui T, Miyata K, Araie M, et al. Autologous transplantation of conjunctival epithelial cells cultured on amniotic membrane in a rabbit model. Mol Vis. 2007;13:1138–43.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Usui T, Nakagawa S, Yokoo S, Mimura T, Yamagami S, Amano S. Bilateral limbal stem cell deficiency with chromosomal translocation of 3p and 9p. Jpn J Ophthalmol. 2010;54:357–8.CrossRefGoogle Scholar
  10. 10.
    Sotozono C, Inatomi T, Nakamura T, Koizumi N, Yokoi N, Ueta M, et al. Cultivated oral mucosal epithelial transplantation for persistent epithelial defect in severe ocular surface diseases with acute inflammatory activity. Acta Ophthalmol. 2014;92:e447–53.CrossRefGoogle Scholar
  11. 11.
    Nakamura T, Takeda K, Inatomi T, Sotozono C, Kinoshita S. Long-term results of autologous cultivated oral mucosal epithelial transplantation in the scar phase of severe ocular surface disorders. Br J Ophthalmol. 2011;95(942–6):12.Google Scholar
  12. 12.
    Moyer PD, Kaufman AH, Zhang Z, Kao CW, Spaulding AG, Kao WW. Conjunctival epithelial cells can resurface denuded cornea, but do not transdifferentiate to express cornea-specific keratin 12 following removal of limbal epithelium in mouse. Differentiation. 1996;60:31–8.CrossRefGoogle Scholar
  13. 13.
    Cho BJ, Djalilian AR, Obritsch WF, Matteson DM, Chan CC, Holland EJ. Conjunctival epithelial cells cultured on human amniotic membrane fail to transdifferentiate into corneal epithelial-type cells. Cornea. 1999;18:216–24.CrossRefGoogle Scholar
  14. 14.
    Kawasaki S, Tanioka H, Yamasaki K, Yokoi N, Komuro A, Kinoshita S. Clusters of corneal epithelial cells reside ectopically in human conjunctival epithelium. Investig Ophthalmol Vis Sci. 2006;47:1359–67.CrossRefGoogle Scholar
  15. 15.
    Lavker RM, Tseng SC, Sun TT. Corneal epithelial stem cells at the limbus: looking at some old problems from a new angle. Exp Eye Res. 2004;78:433–46.CrossRefGoogle Scholar
  16. 16.
    Eslani M, Baradaran-Rafii A, Ahmad S. Cultivated limbal and oral mucosal epithelial transplantation. Semin Ophthalmol. 2012;27:80–93.CrossRefGoogle Scholar
  17. 17.
    Silber PC, Ricardo JR, Cristovam PC, Hazarbassanov RM, Dreyfuss JL, Gomes JA. Conjunctival epithelial cells cultivated ex vivo from patients with total limbal stem cell deficiency. Eur J Ophthalmol. 2015;25:60–4.CrossRefGoogle Scholar
  18. 18.
    Thoft RA. Conjunctival transplantation. Arch Ophthalmol. 1977;95:1425–7.CrossRefGoogle Scholar
  19. 19.
    Thoft RA. Conjunctival transplantation as an alternative to keratoplasty. Ophthalmology. 1979;86:1084–92.CrossRefGoogle Scholar
  20. 20.
    Jirsova K, Jones GLA. Amniotic membrane in ophthalmology: properties, preparation, storage and indications for grafting-a review. Cell Tissue Bank. 2017;18:193–204.CrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2019

Authors and Affiliations

  • Tohru Sakimoto
    • 1
  • Akira Sakimoto
    • 1
  • Satoru Yamagami
    • 1
    Email author
  1. 1.Division of Ophthalmology, Department of Visual SciencesNihon University School of MedicineTokyoJapan

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