Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency
Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency
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DOI：
10.1001/archopht.116.4.431
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发表时间：
1998-04-01
影响因子：
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通讯作者：
Meller, D
中科院分区：
文献类型：
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作者：
Tseng, SCG;Prabhasawat, P;Meller, D
目的：目的：探讨羊膜移植（AMT）在角膜缘周围基质准备过程中是否能提高同种异体角膜缘移植（ALT）的成功率。方法：26例31眼角膜缘细胞学检查证实为角膜缘缺损的患者，其中化学烧伤14眼，Stevens-Johnson综合征、中毒性表皮坏死松解症或假性天疱疮5眼，角膜接触镜引起的角膜病变3眼，角膜移植术后角膜缘细胞学检查证实为角膜缘细胞学缺损。无虹膜（3只眼）;多次手术（2只眼）;特应性（2只眼）;或原因不明（2只眼）。根据角膜缘缺损的严重程度，A组（轻度）10眼，单纯行AMT; B组（中度）7眼，行AMT + ALT; C组（重度）14眼，行AMT + ALT+穿透性角膜移植。结果：除2只特应性眼外，所有患者羊膜覆盖表面均在2 ~ 4周内迅速上皮化，炎症、血管形成和瘢痕形成减少，表面变得光滑、透明。平均随访15.4个月，30只眼中有25只眼（83%）显示视力改善，包括6行或更多行（13只眼），4 - 5行（6只眼）或1 - 3行（6只眼）。视力改善随角膜缘缺损程度的加重而下降，A组8/8眼（100%），B组7/5眼（71%），C组14/11眼（79%）。C组14只眼中有9只眼（64%）发生角膜移植排斥反应，B组和C组21只眼中有3只眼（14%）发生可逆性早期角膜缘移植排斥反应。结论：对于部分角膜缘缺损伴表浅受累的患者，单独应用AMT是足够的，因此上级优于ALT，因为不需要使用环孢素。对于完全角膜缘缺陷，需要额外的ALT，AMT有助于重建角膜缘周围基质，减少炎症和血管形成，这共同可能提高ALT的成功率。
Objective: To examine whether amniotic membrane transplantation (AMT), in preparing the perilimbal stroma, enhances the success of allograft limbal transplantation (ALT).Methods: Thirty-one eyes of 26 consecutive patients had cytologically proven limbal deficiency resulting from chemical burns (14 eyes); Stevens-Johnson syndrome, toxic epidermal necrolysis, or pseudopemphigoid (5 eyes); contact lens-induced keratopathy (3 eyes); aniridia (3 eyes); multiple surgical procedures (2 eyes); atopy (2 eyes); or an unknown cause (2 eyes). Based on the severity of limbal deficiency, group A (mild), comprising 10 eyes, received AMT alone; group B (moderate), comprising 7 eyes, received AMT and ALT; and group C (severe), comprising 14 eyes, received AMT, ALT, and penetrating keratoplasty. All patients except those in group A received continuous oral cyclosporine.Results: Except for the 2 eyes with atopy, all amniotic membrane-covered surfaces showed rapid epithelialization (in 2 to 4 weeks) and reduced inflammation, vascularization, and scarring, and the surfaces became smooth and wettable. For the mean follow-up period of 15.4 months, 25 (83%) of 30 eyes showed visual improvement, consisting of 6 or more lines (13 eyes), 4 to 5 lines (6 eyes), or 1 to 3 lines (6 eyes). Visual improvement decreased with the severity of limbal deficiency from 8 (100%) of 8 eyes in group A to 5 (71%) of 7 eyes in group B and 11 (79%) of 14 eyes in group C. In group C, corneal graft rejection occurred in 9 (64%) of 14 eyes, and reversible early limbal allograft rejection was noted in 3 (14%) of 21 eyes of groups B and C.Conclusions: For partial limbal deficiency with superficial involvement, AMT alone is sufficient and hence superior to ALT because there is no need to administer cyclosporine. For total limbal deficiency, additional ALT is needed, and AMT helps reconstruct the perilimbal stroma, with reduced inflammation and vascularization, which collectively may enhance the success of ALT.