Long-term Outcomes of Keratolimbal Allograft for Total Limbal Stem Cell Deficiency Using Combined Immunosuppressive Agents and Correction of Ocular Surface Deficits
Long-term Outcomes of Keratolimbal Allograft for Total Limbal Stem Cell Deficiency Using Combined Immunosuppressive Agents and Correction of Ocular Surface Deficits
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DOI：
10.1001/archophthalmol.2009.263
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发表时间：
2009-11-01
影响因子：
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通讯作者：
Tseng, Scheffer C. G.
中科院分区：
文献类型：
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作者：
Liang, Lingyi;Sheha, Hosam;Tseng, Scheffer C. G.
目的：确定同种异体角膜缘移植（KLAL）的长期结果。方法：计算并记录不频繁眨眼、眨眼相关的微创伤、结膜炎症、眼压升高、干眼、睑融合、兔眼以及既往 KLAL 或穿透性角膜移植术（PKP）失败等风险的评分， KLAL 期间和之后。 KLAL 后，对 12 只眼睛（10 名连续患者）进行了角膜缘干细胞完全缺乏的长期口服吗替麦考酚酯和他克莫司以及短期泼尼松和阿昔洛韦治疗。十只眼睛接受了随后的 PKP。结果：对于风险评分较高的眼睛，需要采取更多的纠正措施。在 KLAL 后 61.2 个月的随访期间（标准差 [SD]，18.2；范围，36-91 个月），术后上皮由于暴露而破裂发生在 PKP 后的后期，并且仍然是主要风险。平均每日剂量为 1.4 g 霉酚酸酯和 1.6 mg 他克莫司，持续 52.7 个月（SD，22.5；范围，23-91 个月），不良反应很少，分别达到 1.6 μg/mL（SD，0.6 μg/mL）和 4.5 ng/mL（SD，2 ng/mL）的谷值水平。分别有 2 只和 3 只眼睛出现同种角膜缘移植和 PKP 排斥反应，但每组中有 1 只眼睛出现逆转，分别有 10 只和 8 只眼睛最终 KLAL 和 PKP 存活，并且在整个随访期间，10 只眼睛的动态视力高达 20/20，占整个随访期的 67.2%。结论：眼表缺陷的矫正与免疫抑制剂相结合养生法 进一步改善角膜缘干细胞完全缺乏的眼睛 KLAL 的长期结果。
Objective: To determine the long-term outcomes of keratolimbal allograft (KLAL).Methods: Scores of such risks as infrequent blinking, blink-related microtrauma, conjunctival inflammation, elevated intraocular pressure, dry eye, symblepharon, lagophthalmos, and previous KLAL or penetrating keratoplasty (PKP) failure were calculated and recorded before, during, and after KLAL. Prolonged oral mycophenolate mofetil and tacrolimus and short-term prednisone and acyclovir were administered in 12 eyes (10 consecutive patients) with total limbal stem cell deficiency after KLAL. Ten eyes underwent subsequent PKP.Results: More corrective measures were required in eyes with higher risk scores. During a follow-up of 61.2 months (standard deviation [SD], 18.2; range, 36-91 months) after KLAL, postoperative epithelial breakdown due to exposure occurred late in the period after PKP and remained a primary risk. Mean daily doses of 1.4 g of mycophenolate mofetil and 1.6 mg of tacrolimus were administered for 52.7 months (SD, 22.5; range, 23-91 months) with few adverse effects and reached trough levels of 1.6 mu g/mL (SD, 0.6 mu g/mL) and 4.5 ng/mL (SD, 2 ng/mL), respectively. Keratolimbal allograft and PKP rejection was noted in 2 and 3 eyes, respectively, though there was a reversal in 1 eye in each group, yielding final KLAL and PKP survivals in 10 and 8 eyes, respectively, and ambulatory visual acuity of up to 20/20 in 10 eyes for 67.2% of the entire follow-up period.Conclusion: Correction of ocular surface deficits combined with an immunosuppressive regimen further improves the long-term outcome of KLAL in eyes with total limbal stem cell deficiency.