Long-term outcomes of keratolimbal allograft for the treatment of severe ocular surface disorders
Long-term outcomes of keratolimbal allograft for the treatment of severe ocular surface disorders
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DOI：
10.1016/s0161-6420(02)01081-3
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发表时间：
2002-07-01
期刊：
影响因子：
13.7
通讯作者：
Daya, SM
中科院分区：
文献类型：
--
作者：
Ilari, L;Daya, SM
目的：观察同种异体角膜缘移植(KLAL)治疗严重眼表疾病的远期疗效。设计：非对照病例系列。研究对象：20例(23只眼)严重眼表疾病患者。干预：33例KLAL手术。10例(10只眼)行KLAL联合其他手术。15例患者术后口服或局部应用环孢素，以预防移植排斥反应。主要观察指标：重建眼表，恢复表型角膜上皮，减少角膜血管形成和结膜形成，减轻疼痛，改善视力。结果：平均随访60个月(15~96个月)。8只眼(24.2%)从未再上皮化，被认为是原发失败。其余25个移植物最初恢复了表型角膜上皮，但最后随访时只有7个(21.2%)是稳定的。移植物存活率1年为54.4%，2年为33.3%，3年为27.3%。视力提高或不变19眼(82.6%)，下降4眼(17.4%)。17例角膜移植(3例板层角膜成形术和14例穿透性角膜成形术)在KLAL联合或术后进行。三次板层角膜成形术全部成功，而14次穿透性角膜成形术中有13次失败。环孢素最初用于高危受者，后来用于所有受者。同种异体移植排斥反应发生在11只眼的13次KLAL手术中(39.4%)，接受环孢素治疗的患者比未接受治疗的患者更常见(87.5%比22.2%)。结论：同种异体角膜缘移植可用于眼表重建和表型角膜上皮的修复。然而，移植物存活率在两年内急剧下降。长期使用环孢素似乎可以延长移植物的存活时间，但不能防止急性同种异体移植物排斥反应。美国眼科学会眼科2002,109：1278-1284(C)2002。
Purpose: To investigate the long-term outcome of keratolimbal allograft (KLAL) for the treatment of severe ocular surface disorders.Design: Retrospective, noncomparative case series.Participants: Twenty patients (23 eyes) with severe ocular surface disorders.Intervention: Thirty-three KLAL procedures were performed. Ten patients (10 eyes) underwent KLAL in combination with other surgical procedures. Oral or topical cyclosporine or both were used after surgery in 15 patients to prevent allograft rejection.Main Outcome Measures: Reconstruction of the ocular surface with restoration of phenotypic corneal epithelium, reduction of corneal vascularization and conjunctivalization, decreased pain, and visual improvement.Results: The mean follow-up was 60 months (range, 15-96 months). Eight eyes (24.2%) never reepithelialized and were considered primary failures. The remaining 25 grafts initially restored a phenotypic corneal epithelium, but at last follow-up only 7 (21.2%) were stable. Graft survival rate was 54.4% at 1 year, 33.3% at 2 years, and 27.3% at 3 years. Visual acuity improved or was unchanged in 19 eyes (82.6%) and decreased in 4 eyes (17.4%). Seventeen corneal transplantations (3 lamellar keratoplasties and 14 penetrating keratoplasties) were performed either in combination with or after a KLAL. All three lamellar keratoplasties were successful, whereas 13 of the 14 penetrating keratoplasties failed. Cyclosporine was used initially in high-risk recipients and later in all recipients. Allograft rejection episodes occurred in 13 KLAL procedures of 11 eyes (39.4%) and were more common in patients treated with cyclosporine compared with the untreated group (87.5% vs. 22.2%). Graft survival was longer in the cyclosporine-treated group compared with the untreated group.Conclusions: Keratolimbal allograft is useful in ocular surface reconstruction and restores phenotypic corneal epithelium. Graft survival rate, however, decreases dramatically over a 2-year period. Long-term use of cyclosporine appears to prolong graft survival but does not prevent acute allograft rejections. Ophthalmology 2002,109:1278-1284 (C) 2002 by the American Academy of Ophthalmology.