Management of aniridic keratopathy with keratolimbal allograft: A limbal stem cell transplantation technique
Management of aniridic keratopathy with keratolimbal allograft: A limbal stem cell transplantation technique
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DOI：
10.1016/s0161-6420(02)01451-3
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发表时间：
2003-01-01
期刊：
影响因子：
13.7
通讯作者：
Schwartz, GS
中科院分区：
文献类型：
--
作者：
Holland, EJ;Djalilian, AR;Schwartz, GS
目的：无虹膜性角膜病变是无虹膜患者视力下降的主要原因。穿透性角膜移植术已被证明对这种疾病的长期治疗无效，因为它没有解决干细胞缺乏这一主要病因。我们评估角膜缘移植（KLAL），一种干细胞移植技术，在治疗无虹膜角膜病变患者中的作用。设计：回顾性非比较性干预病例系列。参与者：23例无虹膜角膜病变患者的31只眼。干预：KLAL。主要结果指标：眼表面稳定性、视力和后续穿透性或板层角膜移植术的成功率。结果：23例31眼采用KLAL治疗，随访12 ~ 7个月，平均35.7个月。23只眼（74.2%）获得稳定的眼表。总体而言，平均视力从20/1000改善至20/165。20只眼（64.5%）随后接受了穿透性角膜移植术。14例角膜移植成功（70.0%），6例失败（30.0%）。21只接受免疫抑制的眼中有19只（90.5%）眼表稳定，而10只未接受免疫抑制的眼中只有4只（40.0%）眼表稳定（P < 0.01）。与仅接受局部免疫抑制的患者相比，接受全身免疫抑制的患者实现眼表稳定和视力改善的可能性更大。(C)2003年，美国眼科学会。
Objective: Aniridic keratopathy is a major cause of vision loss in patients with aniridia. Penetrating keratoplasty has been proven ineffective for the long-term treatment of this disorder because it does not address the stem cell deficiency that is the primary etiologic factor. We evaluated the role of keratolimbal allograft (KLAL), a stem cell transplantation technique, for the treatment of patients with aniridic keratopathy.Design: Retrospective noncomparative interventional case series.Participants: Thirty-one eyes of 23 patients with aniridic keratopathy.Intervention: KLAL.Main Outcome Measures: Ocular surface stability, visual acuity, and success of subsequent penetrating or lamellar keratoplasty.Results: Thirty-one eyes of 23 patients were treated with KLAL and followed up for 12 toll 7 months (mean, 35.7 months). Twenty-three eyes (74.2%) achieved a stable ocular surface. Overall, the mean visual acuity improved from 20/1000 to 20/165. Twenty eyes (64.5%) underwent subsequent penetrating keratoplasty. Fourteen corneal transplant grafts (70.0%) were successful, and six (30.0%) failed. Nineteen (90.5%) of 21 eyes receiving systemic immunosuppression obtained a stable ocular surface, whereas only 4 (40.0%) of 10 eyes not receiving systemic immunosuppression achieved ocular surface stability (P < 0.01).Conclusions: KLAL is effective in treating aniridic keratopathy. Patients receiving systemic immunosuppression have a greater likelihood of achieving ocular surface stability and improved visual acuity compared with those who receive only topical immunosuppression. (C) 2003 by the American Academy of Ophthalmology.