Clinical Outcomes of Repeat Autologous Cultivated Limbal Epithelial Transplantation for Ocular Surface Burns
Clinical Outcomes of Repeat Autologous Cultivated Limbal Epithelial Transplantation for Ocular Surface Burns
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DOI：
10.1016/j.ajo.2011.09.016
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发表时间：
2012-04-01
影响因子：
4.2
通讯作者：
Sangwan, Virender S.
中科院分区：
文献类型：
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作者：
Basu, Sayan;Ali, Md Hasnat;Sangwan, Virender S.
目的：报告重复培养的自体角膜缘上皮移植治疗一期手术失败后复发的角膜缘干细胞缺乏症患者的临床结果。设计：回顾性病例系列。方法：2001年至2010年收治的50例8岁以上临床诊断为单侧角膜缘干细胞缺乏症的眼表烧伤患者。在一次手术失败后，所有患者都从未受影响的眼睛接受了重复的角膜缘活检。采用完全无异种外植体培养技术，在人羊膜基质上体外扩增角膜缘细胞10~14天。由此产生的培养上皮单层和羊膜被移植到患者的患眼上。所有患者在每次随访时都进行了双眼的全面眼科检查。结果：平均随访2.3±1.4年(中位数：1.96，范围1~7.5)，50只受者中33只眼(66%)保持了完全上皮化、无血管和临床稳定的角膜表面。在50只受者眼中，38只眼(76%)的视力提高了2行。所有供眼均未出现任何眼表疾病、供体结膜过度生长或视力下降的临床表现。结论：重复培养的自体角膜缘上皮移植成功地恢复了角膜上皮的稳定性，改善了一期手术失败后复发的角膜缘干细胞缺乏症患者的视力，且不会对供眼造成不良影响。《眼科杂志》2012；153：643-650。(C)2012年由Elsevier Inc.保留所有权利。)
PURPOSE: To report the clinical outcomes of repeat autologous cultivated limbal epithelial transplantation in patients with recurrence of limbal stem cell deficiency after a failed primary procedure.DESIGN: Retrospective case series.METHODS: This study included 50 patients, above 8 years of age, with clinically diagnosed unilateral limbal stem cell deficiency following ocular surface burns, treated between 2001 and 2010. Following failure of primary surgery all patients underwent a repeat limbal biopsy from the unaffected eye. The limbal cells were expanded ex vivo on a human amniotic membrane substrate for 10 to 14 days using a completely xeno-free explant culture technique. The resulting cultured epithelial monolayer and amniotic membrane were transplanted onto the patient's affected eye. All patients underwent a comprehensive ophthalmic examination of both eyes at every follow-up visit. Postoperative corneal surface stability, change in visual acuity, and complications were objectively analyzed.RESULTS: At a mean follow-up of 2.3 +/- 1.4 (median: 1.96, range: 1 to 7.5) years, 33 of the 50 recipient eyes (66%) maintained a completely epithelialized, avascular, and clinically stable corneal surface. A 2-line improvement in visual acuity was seen in 38 of the 50 recipient eyes (76%). None of the donor eyes developed any clinical features of ocular surface disease, conjunctival overgrowth of the donor site, or decrease in vision throughout the follow-up period.CONCLUSIONS: Repeat autologous cultivated limbal epithelial transplantation successfully restores corneal epithelial stability and improves vision in eyes with recurrence of limbal stem cell deficiency, following failed primary surgery for ocular burns, without adversely affecting donor eyes. (Am J Ophthalmol 2012;153: 643-650. (C) 2012 by Elsevier Inc. All rights reserved.)