Outcomes of Cultivated Oral Mucosal Epithelial Transplantation in Eyes With Chronic Stevens- Johnson Syndrome Sequelae
Outcomes of Cultivated Oral Mucosal Epithelial Transplantation in Eyes With Chronic Stevens- Johnson Syndrome Sequelae
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DOI：
10.1016/j.ajo.2020.08.022
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发表时间：
2021-02-01
影响因子：
4.2
通讯作者：
Sharma, Namrata
中科院分区：
文献类型：
--
作者：
Venugopal, Renu;Nagpal, Ritu;Sharma, Namrata
目的：探讨培养口腔黏膜上皮移植（COMET）治疗慢性史蒂文斯-约翰逊综合征（SJS）后遗症的疗效。设计:前瞻性介入病例系列。方法：从2013年到2017年，在一个机构环境中招募41例慢性SJS后遗症患者的45只眼睛并进行评估。所有患者均行彗星手术，目的是穹窿重建和视力恢复。随访2年，记录矫正距离视力（CDVA）变化、眼表各项参数严重程度评分及并发症发生情况。通过眼表严重程度评分的变化来评估，获得和维持稳定的眼表是主要的结局指标，而CDVA的变化是次要的结局指标。结果：术前平均CDVA为2.7 +/- 0.5 logMAR，术后1年和2年随访时分别改善至1.5 +/- 0.7 logMAR和1.49 +/- 0.98。总体而言，82.2%（37/45）眼视力改善，13.3%（6/45）眼视力无变化，2只眼视力恶化（4.4%）。在2年的随访中，总眼表严重程度评分从术前的平均值29.1 +/- 9.7提高到术后的18.7 +/- 7.2。两只眼睛出现持续性上皮缺损，进展到角膜融化需要角膜移植。结论：对于患有SJS慢性后遗症的眼睛，COMET可以成功和持续地恢复眼表解剖结构并改善功能。
PURPOSE: To study the outcomes of cultivated oral mucosal epithelial transplantation (COMET) in eyes with chronic Stevens-Johnson syndrome (SJS) sequelae.DESIGN: Prospective interventional case series.METHODS: Forty-five eyes of 41 patients with chronic SJS sequelae were recruited and evaluated from 2013 to 2017 in an institutional setting. All patients underwent COMET, with an aim of fornix reconstruction and visual rehabilitation. Change in corrected distance visual acuity (CDVA), severity scores of various ocular surface param-eters, and the occurrence of complications were docu-mented during a follow up period of 2 years. Attainment and maintenance of a stable ocular surface, as assessed by change in the ocular surface severity scores was the primary outcome measure, while change in CDVA was the secondary outcome measure.RESULTS: The mean preoperative CDVA was 2.7 +/- 0.5 logMAR, which improved to 1.5 +/- 0.7 logMAR and 1.49 +/- 0.98 postoperatively, at 1-and 2-year follow-up visit. Overall, 82.2% eyes (37/45) had improvement in visual acuity, 13.3% (6/45) experienced no change, whereas 2 eyes (4.4%) had worsening of visual acuity. The total ocular surface severity scores improved from a mean preoperative value of 29.1 +/- 9.7 to 18.7 +/- 7.2 post-operatively, at 2-year follow-up. Two eyes developed persistent epithelial defects, with progression to corneal melting requiring keratoplasty.CONCLUSIONS: COMET allows successful and sus-tained restoration of ocular surface anatomy with func-tional improvement, in eyes with chronic sequelae of SJS.