Long-term result of autologous cultivated oral mucosal epithelial transplantation for severe ocular surface disease
Long-term result of autologous cultivated oral mucosal epithelial transplantation for severe ocular surface disease
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DOI：
10.1007/s10561-016-9575-4
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发表时间：
2016-09-01
影响因子：
1.5
通讯作者：
Luemsamran, Panitee
中科院分区：
文献类型：
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作者：
Prabhasawat, Pinnita;Ekpo, Pattama;Luemsamran, Panitee
本研究旨在探讨自体培养口腔粘膜上皮移植（COMET）在人羊膜（AM）上治疗角膜缘干细胞缺乏症（LSCD）的临床效果。在该前瞻性、非比较性病例系列中，选择了20只患有双侧严重眼表疾病的眼睛（18例患者）对人AM进行COMET。主要结局是临床成功，次要结局是最佳矫正视力差异、角膜混浊、睑球粘连形成和并发症。患者平均年龄为48.2 ± 15.5岁。平均随访时间为31.9 ± 12.1个月（范围8-50个月）。除一只眼外，所有眼在术后第一周内均表现出完全上皮化。成功的临床结局定义为无上皮缺损的稳定眼表、瞳孔区无纤维血管组织浸润的透明角膜以及无或轻度眼表炎症，20只眼中有15只眼（75%）获得了成功的临床结局。1年的临床成功率为79.3%，4年（随访结束）的临床成功率为70.5%。14/20眼（70%）在COMET后视力有所改善，有些需要后续的白内障手术（2眼）、穿透性角膜移植术（3眼）或人工角膜植入术（1眼）。术前睑球粘连消失者8眼（61.5%）.唯一的并发症是严重眼睑异常引起的角膜穿孔（1只眼）;采用构造性角膜移植术治疗成功。COMET可以成功地恢复大多数角膜LSCD患者的眼表损伤。
The present study aimed to investigate the clinical outcomes of autologous cultivated oral mucosal epithelial transplantation (COMET) on human amniotic membrane (AM) for corneal limbal stem cell deficiency (LSCD). In this prospective, noncomparative case series, 20 eyes (18 patients) with bilateral severe ocular surface disease were chosen to undergo COMET on human AM. The primary outcome was clinical success, and the secondary outcomes were the best-corrected visual acuity difference, corneal opacification, symblepharon formation, and complications. The mean patient age was 48.2 +/- A 15.5 years. The mean follow-up time was 31.9 +/- A 12.1 months (range 8-50 months). All except one eye exhibited complete epithelialization within the first postoperative week. A successful clinical outcome, defined as a stable ocular surface without epithelial defects, a clear cornea without fibrovascular tissue invasion at the pupillary area, and no or mild ocular surface inflammation, was obtained in 15 of 20 eyes (75 %). The clinical success rate at 1 year was 79.3 %, and that at 4 years (end of follow-up) was 70.5 %. Fourteen of 20 (70 %) eyes exhibited improvement in visual acuity after COMET, and some required subsequent cataract surgery (2 eyes), penetrating keratoplasty (3 eyes), or keratoprosthesis implantation (1 eye). Preoperative symblepharon was eliminated in most eyes (8 of 13, 61.5 %) after COMET combined with eyelid reconstruction when needed. The only complication was corneal perforation (1 eye) induced by a severe eyelid abnormality; treatment with a tectonic corneal graft was successful. COMET can successfully restore ocular surface damage in most eyes with corneal LSCD.