Cultivated corneal epithelial stem cell transplantation in ocular surface disorders
Cultivated corneal epithelial stem cell transplantation in ocular surface disorders
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DOI：
10.1016/s0161-6420(01)00694-7
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发表时间：
2001-09-01
期刊：
影响因子：
13.7
通讯作者：
Kinoshita, S
中科院分区：
文献类型：
--
作者：
Koizumi, N;Inatomi, T;Kinoshita, S
用途：探讨培养角膜上皮移植严重干细胞缺陷的结果，使用剥脱羊膜（AM）作为carrier.Design：回顾性，noncomparative病例series.Participants：11例患者的13只眼进行了研究。其中5只眼为急性Stevens-Johnson综合征（SJS），2只眼为慢性SJS，1只眼为急性化学损伤，2只眼为慢性化学损伤，2只眼为眼部瘢痕性类天疱疮，1只眼为药物诱导的假类天疱疮。所有这些眼睛有总干细胞deficiency.Main结果测量：适应培养的角膜上皮对宿主角膜表面被证实术后48小时。方法：取供体角膜缘上皮，在裸AM载体上培养4周，与3 T3成纤维细胞共培养，空气提拉。培养的角膜上皮呈4 ~ 5层分层，分化良好。在从角膜上除去利姆布斯外3 mm的结膜组织并用0.04%丝裂霉素C处理结膜下组织后，将培养的同种异体角膜上皮，包括AM载体，移植到角膜表面上直至利姆布斯。使用保存的供体移植物无上皮，板层角膜移植术，同时进行5个慢性期患者显示角膜基质瘢痕。全身免疫抑制用于防止同种异体移植排斥反应。结果：在所有13只眼中，整个角膜表面，其上培养的异体角膜上皮已被放置，是免费的上皮缺损手术后48小时，表明移植角膜上皮完全存活。术后所有患眼视力均提高，其中10只眼术后6个月视力恢复良好（术后视力提高2行或2行以上）。在随访期间（平均标准差为11.2 ± 1.3个月），角膜表面清晰，尽管有3只眼出现上皮排斥反应。以裸羊膜为载体的培养角膜上皮移植可用于治疗严重的干细胞缺乏症。(C)2001年由美国眼科学会。
Purpose: To investigate the outcome of cultivated corneal epithelial transplantation for severe stem cell deficiencies using denuded amniotic membrane (AM) as a carrier.Design: Retrospective, noncomparative case series.Participants: Thirteen eyes of 11 patients were studied. These consisted of five eyes with acute Stevens-Johnson syndrome (SJS), two with chronic SJS, one with an acute chemical injury, two with chronic chemical injuries, two with ocular cicatricial pemphigoid, and one with drug-induced pseudopemphigoid. All of these eyes had total stem cell deficiencies.Main Outcome Measures: Adaptation of the cultivated corneal epithelium onto the host corneal surface was confirmed 48 hours after surgery. The reconstruction of the ocular surface and visual acuity were measured.Methods: Corneal limbal epithelium from donor corneas was cultivated for 4 weeks on a denuded AM carrier, with 3T3 fibroblast coculture and air lifting. The cultivated corneal epithelium showed four to five layers of stratification and was well differentiated. After conjunctival tissue removal from the cornea up to 3 mm outside the limbus and subconjunctival tissue treatment with 0.04% mitomycin C, cultivated allocorneal epithelium, including the AM carrier, was transplanted onto the corneal surface up to the limbus. Lamellar keratoplasty, using preserved donor graft without epithelium, was performed simultaneously for five chronic-phase patients showing corneal stromal scarring. Systemic immunosuppression was used to prevent allograft rejection.Results: In all 13 eyes, the entire corneal surface, on which cultivated allocorneal epithelium had been placed, was free from epithelial defects 48 hours after surgery, indicating complete survival of the transplanted corneal epithelium. Visual acuity improved in all eyes after surgery, and 10 of the 13 eyes were restored to good vision (postoperative visual acuity improved two or more lines) 6 months after the operation. During the follow-up period (mean standard deviation, 11.2 +/- 1.3 months), the corneal surfaces were clear, although three eyes experienced epithelial rejection.Conclusions. Cultivated corneal epithelial transplantation using denuded AM as a carrier can be used for severe stem cell deficiencies. (C) 2001 by the American Academy of Ophthalmology.