Ocular surface reconstruction with combination of cultivated autologous oral mucosal epithelial transplantation and penetrating keratoplasty
Ocular surface reconstruction with combination of cultivated autologous oral mucosal epithelial transplantation and penetrating keratoplasty
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DOI：
10.1016/j.ajo.2006.06.004
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发表时间：
2006-11-01
影响因子：
4.2
通讯作者：
Kinoshita, Shigeru
中科院分区：
文献类型：
--
作者：
Inatomi, Tsutomu;Nakamura, Takahiro;Kinoshita, Shigeru
目得：报告一项评估两步手术联合培养的自体口腔粘膜上皮移植（COMET）和穿透性角膜移植（PKT）用于治疗严重角膜缘缺陷疾病患者，并研究移植存活口腔粘膜上皮角蛋白表达模式。设计：观察性病例系列。2例Stevens-Johnson综合征和化学性眼损伤患者接受COMET治疗，约6个月后接受PKP三联手术。在平均22.5个月的随访期间，评估了他们的临床结局和这种两步手术的有效性。此外，在PKP过程中切除的角膜纽扣中的角蛋白表达进行了免疫化学检测，以表征在角膜上异位存活的口腔粘膜上皮。结果：用培养的自体口腔粘膜上皮片和PKP成功地重建了眼表。没有临床并发症，如持续性上皮缺损，排斥反应，或复发的瘢痕，遇到。术后最佳矫正视力分别为20/125和20/100。存活的口腔粘膜上皮，其荧光模式的区别，包括不规则的，非角化，复层上皮无杯状细胞。免疫组织化学研究表明，移植培养的口腔粘膜上皮中表达K3，而不表达K12，与口腔粘膜组织相似。在体内，上皮结构和细胞密度在基底细胞层的角膜移植物是类似于正常corne.CONCLUSIONS：这项研究提出了一个两步的手术方法来治疗严重疤痕眼表通过组合的COMET和PKP。临床结果表明，这种治疗可能有利于通过提供角膜移植物周围的口腔粘膜上皮来维持重建的眼表。
PURPOSE: To report an assessment of the two-step surgical combination of cultivated autologous oral mucosal epithelial transplantation (COMET) and penetrating keratoplasty (PKT) used to treat patients with severe limbal deficiency disorders, and to investigate the keratin expression patterns of transplanted surviving oral muco, sal epithelium.DESIGN: Observational case series.METHODS: Two patients with Stevens-Johnson syndrome and chemical eye injury were treated by COMET followed, approximately six months later, by a PKP triple procedure. In the course of a mean follow-up period of 22.5 months, their clinical outcomes and the efficacy of this two-step surgical procedure were assessed. In addition, the keratin expression in corneal buttons excised during PKP were immunohistochemically examined to characterize the oral mucosal epithelium that survived ectopically on the cornea. In vivo laser confocal microscopy was used to investigate the structure of the epithelium on the corneal grafts.RESULTS: The ocular surfaces were successfully reconstructed with cultivated autologous oral mucosal epithelial sheets and PKP. No clinical complications, such as persistent epithelial defects, rejections, or recurrence of cicatrization, were encountered. Postoperative best-corrected visual acuity was 20/125 in one patient and 20/100 in the other. The surviving oral mucosal epithelium, distinguished by its fluorescence pattern, consisted of an irregular, nonkeratinized, stratified epithelium without goblet cells. Immunohistochemical study demonstrated that K3, but not K12, was expressed in the transplanted cultivated oral mucosal epithelium that was similar to oral mucosal tissue. In vivo, the epithelial structure and cell density in the basal cell layer of the corneal grafts were similar to normal cornea.CONCLUSIONS: This study presents a two-step surgical approach to treat severely scarred ocular surfaces by means of a combination of COMET and PKP. Clinical outcomes suggest that this treatment may be beneficial for the maintenance of the reconstructed ocular surface by providing oral mucosal epithelium around the corneal graft.