Living related conjunctival limbal allograft for the treatment of stem cell deficiency
Living related conjunctival limbal allograft for the treatment of stem cell deficiency
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DOI：
10.1016/s0161-6420(00)00475-9
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发表时间：
2001-01-01
期刊：
影响因子：
13.7
通讯作者：
Ilari, L
中科院分区：
文献类型：
--
作者：
Daya, SM;Ilari, L
目的：评价活体亲属结膜缘同种异体移植治疗干细胞缺乏症的结果。设计：回顾性，非比较性病例系列。参与者：供者9例，受体8例（10眼），其中Stevens-Johnson综合征3例（3眼），外胚层发育不良3例（3眼），化学损伤2例（2眼），眼瘢痕性类天疱疮1例（1眼），和特应性角结膜炎（n = 1）。干预：在结膜周边切开并去除结膜血管翳后，将来自最匹配的人类白细胞抗原（HLA）亲属供体的4个小时的角膜缘结膜组织从上方和下方移植到受体眼睛。全身环孢素给所有recipient.Main结果Measures：恢复角膜上皮，减少血管和结膜，改善舒适度，提高角膜透明度，视力improvement.Results：平均随访期为26.2个月。两只高度发炎的眼睛最初未能上皮化。其余均存活，角膜上皮恢复，血管减少。角膜混浊减少（4/8只眼），7只眼视力改善。所有五只疼痛的眼睛的症状都有所改善。2眼（25%）发生同种异体移植排斥反应，均成功治疗。两只眼睛都有两个I类HLA错配，并且都有Stevens-Johnson综合征的基础诊断。一只眼睛出现复发性上皮缺损和穿孔，需要穿透性角膜移植术，保持透明，上皮表面完整。最初的两次失败也穿孔，需要穿透性角膜移植术，但失败了。供眼无任何并发症。结论：HLA配型同种异体结膜缘移植眼表的恢复可以在选定的受者完成。全身性环孢霉素，即使在低剂量，是有用的，以确保长期生存。眼科学2001;108：126-134（C）2001，美国眼科学会。
Purpose: To evaluate the outcomes of living related conjunctival limbal allograft transplantation for the treatment of stem cell deficiency.Design: Retrospective, noncomparative case series.Participants: Nine living related donors, eight recipients (10 eyes) with Stevens-Johnson syndrome (3 eyes), ectodermal dysplasia (3 eyes), chemical injury (2 eyes), ocular cicatricial pemphigoid (1 eye), and atopic keratoconjunctivitis (n = 1).Intervention: Four clock hours of limbal conjunctival tissue from the best matched human leukocyte antigen (HLA) relative donor were transplanted to the recipient eye superiorly and inferiorly after conjunctival peritomy and removal of conjunctival pannus. Systemic cyclosporine was administered to all recipients.Main Outcome Measures: Restoration of corneal epithelium, reduction of vascularity and conjunctivalization, improved comfort, improved corneal clarity, and visual improvement.Results: Mean follow-up period was 26.2 months. Two highly inflamed eyes failed to initially epithelialize. The remainder all survived with restoration of corneal epithelium and reduction of vascularization. Corneal opacification was reduced (four of eight eyes) and visual improvement was achieved in seven eyes. All five eyes with pain had an improvement in symptoms. Allograft rejection occurred in two eyes (25%), and both were treated successfully. Both eyes had two class I HLA mismatches, and both had an underlying diagnosis of Stevens-Johnson syndrome. One eye developed a recurrent epithelial defect and perforated, requiring a penetrating keratoplasty that remained clear with an intact epithelial surface. The two initial failures also perforated and required penetrating keratoplasties that failed. None of the donor eyes had any complications.Conclusions: Restoration of the ocular surface by HLA-matched conjunctival limbal allograft transplantation can be accomplished in selected recipients. Systemic cyclosporine, even at low doses, is useful in ensuring long-term survival. Ophthalmology 2001;108:126-134 (C) 2001 by the American Academy of Ophthalmology.