Long-term Outcome of Cultivated Oral Mucosal Epithelial Sheet Transplantation in Treatment of Total Limbal Stem Cell Deficiency
Long-term Outcome of Cultivated Oral Mucosal Epithelial Sheet Transplantation in Treatment of Total Limbal Stem Cell Deficiency
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DOI：
10.1016/j.ophtha.2011.01.039
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发表时间：
2011-08-01
期刊：
影响因子：
13.7
通讯作者：
Shimazaki, Jun
中科院分区：
文献类型：
--
作者：
Satake, Yoshiyuki;Higa, Kazunari;Shimazaki, Jun
目的：评价培养的口腔粘膜上皮移植（COMET）治疗角膜缘干细胞完全缺乏眼的长期疗效。设计：非比较性、回顾性、干预性病例系列。参与者：角膜缘干细胞完全缺乏症36例40只眼（Stevens-Johnson综合征12眼，化学烧伤或热烧伤11眼，眼瘢痕性类天疱疮9眼，假性OCP 7眼，和凝胶状滴状营养不良1眼）在日本千叶东京牙科大学眼科治疗。干预：将培养的自体口腔粘膜上皮片移植到角膜缘干细胞完全缺乏的眼的眼表上。主要结果测量：重建稳定的眼表，外观清晰，无上皮缺损，减少角膜表面的纤维血管组织浸润，功能性穹窿，视力改变，术后并发症。结果：平均随访时间为25.5个月（范围：6-54.9个月）。角膜表面稳定性的Kaplan-Meier分析显示，移植的口腔粘膜上皮稳定性在前6个月早期下降，此后保持相对稳定（1年，64.8%; 2年，59.0%; 3年，53.1%）。术后3个月内9只眼发生持续性上皮衰竭。早期上皮衰竭与术前角膜缺陷密切相关。8眼观察到角膜表面逐渐的纤维血管组织浸润，在OCP病例中明显。功能性穹窿的生存率逐渐下降，直至约6个月。术后视力似乎与角膜混浊的存在有关。并发症包括角膜基质溶解或穿孔8眼，感染性角膜炎2眼，青光眼8眼，单纯疱疹性角膜炎复发1眼。角膜融化或穿孔和感染性角膜炎密切相关的持续上皮缺损后COMET.Conclusions：培养的口腔粘膜上皮片移植提供了一个可行的和安全的替代重建一个稳定的眼表。角膜表面的上皮化不仅在获得令人满意的长期结果方面非常重要，而且在实现较低的并发症发生率方面也非常重要。财务披露：作者在本文中讨论的任何材料中没有专有或商业利益。Ophthalmology 2011; 118：1524-1530（C）2011，美国眼科学会。
Purpose: To evaluate the long-term outcome of cultivated oral mucosal epithelial transplantation (COMET) in treatment of eyes with total limbal stem cell deficiency.Design: Noncomparative, retrospective, interventional case series.Participants: Forty eyes in 36 patients with total limbal stem cell deficiency (Stevens-Johnson syndrome in 12 eyes, chemical or thermal burns in 11 eyes, ocular cicatricial pemphigoid [OCP] in 9 eyes, pseudo-OCP in 7 eyes, and gelatinous drop-like dystrophy in 1 eye) were treated at the Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.Intervention: Cultivated autologous oral mucosal epithelial sheets were transplanted onto the ocular surface in eyes with total limbal stem cell deficiency.Main Outcome Measures: Reconstruction of a stable ocular surface with a clear appearance and no epithelial defects, reduction in fibrovascular tissue invasion of corneal surface, a functional fornix, change in visual acuity, and postoperative complications.Results: The mean follow-up period was 25.5 months (range, 6-54.9 months). Kaplan-Meier analysis of a corneal surface stability revealed an early decline in transplanted oral mucosal epithelial stability over the first 6 months, remaining comparatively stable thereafter (1 year, 64.8%; 2 years, 59.0%; and 3 years, 53.1%). Postoperative persistent epithelial failure developed within the first 3 months in 9 eyes. Early epithelial failure was associated closely with preoperative corneal defects. Gradual fibrovascular tissue invasion of the corneal surface was observed in 8 eyes and was marked in cases of OCP. Survival of a functional fornix decreased progressively until approximately 6 months. Postoperative visual acuity seemed to be related to the presence of corneal opacity. Complications included stromal melting or perforation in 8 eyes, infectious keratitis in 2 eyes, glaucoma in 8 eyes, and recurrence of herpetic keratitis in 1 eye. Corneal melting or perforation and infectious keratitis were associated closely with persistent epithelial defects after COMET.Conclusions: The transplantation of cultivated oral mucosal epithelial sheets offers a viable and safe alternative in the reconstruction of a stable ocular surface. Epithelialization of the corneal surface is very important not only in obtaining a satisfactory long-term outcome, but also in achieving a lower incidence of complications.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2011; 118: 1524-1530 (C) 2011 by the American Academy of Ophthalmology.