Outcomes and DNA analysis of ex vivo expanded stem cell allograft for ocular surface reconstruction
Outcomes and DNA analysis of ex vivo expanded stem cell allograft for ocular surface reconstruction
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DOI：
10.1016/j.ophtha.2004.09.023
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发表时间：
2005-03-01
期刊：
影响因子：
13.7
通讯作者：
James, SE
中科院分区：
文献类型：
--
作者：
Daya, SM;Watson, A;James, SE
目的：研究离体扩增干细胞同种异体移植新技术治疗角膜缘干细胞缺陷（LSCD）的结果，并描述术后眼表基因型的特征。设计：回顾性非比较病例系列。参与者：10 名因外胚层发育不良（3 只眼）、史蒂文斯-约翰逊综合征（3 只眼）、化学损伤（2 只眼）、热损伤（1 只眼）和热损伤（1 只眼）引起的严重 LSCD 患者的 10 只眼睛红斑痤疮眼睑结膜炎（1只眼）。干预：在塑料上培养同种异体角膜缘干细胞，并在去除结膜血管翳后将其移植到受体眼中。羊膜以绷带的形式应用。 2例与其他重建手术联合进行。 9例患者接受全身环孢素A免疫抑制，并通过表面印迹细胞学检查DNA基因型。主要指标：LSCD参数，包括血管化、结膜化、炎症、上皮缺损、畏光和疼痛。结果。平均随访期为 28 个月（范围：12-50）。最终随访时，10 只眼睛中有 7 只 (70%) 的 LSCD 参数有所改善，被认为是成功的。四人 (40%) 的视力有所提高，其中 3 人接受了进一步的视力康复手术。 3 名患者未能改善——1 名患有热烧伤和眼睑畸形，1 名患有史蒂文斯-约翰逊综合征和严重干眼症，1 名患有外胚层发育不良，在 26 个月时出现上皮缺损。前 7 例病例的 DNA 分析显示，9 个月后不存在离体供体干细胞 DNA。 结论：离体扩增干细胞同种异体移植是修复深度 LSCD 眼表的有用技术。超过 9 个月没有供体 DNA 表明持续的免疫抑制可能是不必要的，并引发了关于宿主角膜上皮起源的问题。 (C) 2005 年由美国眼科学会颁发。
Purpose: To investigate the outcome of a new technique of ex vivo expanded stem cell allograft for limbal stem cell deficiency (LSCD), and to characterize the ocular surface genotype after surgery.Design: Retrospective noncomparative case series.Participants: Ten eyes of 10 patients with profound LSCD arising from ectodermal dysplasia (3 eyes), Stevens-Johnson syndrome (3 eyes), chemical injury (2 eyes), thermal injury (1 eye), and rosacea blepharoconjunctivitis (1 eye).Intervention: Allogeneic corneal limbal stem cells were cultured on plastic and transplanted to the recipient eye after removal of conjunctival pannus. Amniotic membrane was applied in a bandage capacity. The procedure was combined with other reconstructive surgery in 2 cases. Nine patients received systemic cyclosporin A immunosuppression, and the DNA genotype was investigated with surface impression cytology.Main Outcome Measures: Parameters of LSCD, including vascularization, conjunctivalization, inflammation, epithelial defect, photophobia, and pain.Results. The mean follow-up period was 28 months (range, 12-50). Seven of 10 eyes (70%) had improved parameters of LSCD at final follow-up and were considered successes. Four (40%) had improved visual acuity, including 3 having had further procedures for visual rehabilitation. Three patients failed to improve-1 with a thermal burn and lid deformity, 1 with Stevens-Johnson syndrome and severe dry eye, and 1 with ectodermal dysplasia who developed an epithelial defect at 26 months. DNA analysis of the first 7 cases showed no ex vivo donor stem cell DNA present beyond 9 months.Conclusions: Ex vivo expanded stem cell allograft is a useful technique for restoring the ocular surface in profound LSCD. The absence of donor DNA beyond 9 months suggests that ongoing immunosuppression may be unnecessary and raises questions regarding the origin of the host corneal epithelium. (C) 2005 by the American Academy of Ophthalmology.