Rao S K, Rajagopal R, Sitalakshmi G, Padmanabhan P
Cornea Service, Sankara Nethralaya, Medical Research Foundation, Chennai, India.
Ophthalmology. 1999 Apr;106(4):822-8. doi: 10.1016/S0161-6420(99)90173-2.
To report the results of limbal allograft transplantation, from human leukocyte antigen (HLA)-matched and -unmatched related live donors, in patients with ocular surface disease due to chemical burns and Stevens-Johnson syndrome.
Retrospective, noncomparative case series.
Eight patients (nine eyes) with severe chemical burns (n = 7 eyes) and Stevens-Johnson syndrome (n = 2 eyes).
Recipient eyes were treated with excision of cicatricial tissues. Transplantation of superior and inferior limbal grafts was performed from related live HLA-matched (n = 7) and -unmatched donors (n = 2). Systemic cyclosporine was not used in any of the recipients.
Reconstruction of corneal surface epithelium, restoration of avascularity, increase in ocular comfort, and improvement in visual acuity.
With a mean observation period of 17.2 months, phenotypically corneal epithelium, decreased vascularization of the corneal surface, and improved ocular comfort were seen in seven (77.8%) eyes. In all seven eyes, gradual recurrence of peripheral corneal vascularization occurred during the follow-up period. Features of graft rejection developed in three (42.9%) of these seven eyes. In two eyes, limbal transplantation from HLA-unmatched donors failed to reconstitute the corneal surface. Limbal allograft transplantation resulted in visual acuity of 20/400 or greater in only two (22.2%) eyes at last follow-up. Corneal grafts performed 7 and 16 months after successful limbal transplantation in two eyes developed recurrent epithelial breakdown and superficial corneal scarring. None of the donor eyes in this study had any complication.
Transplantation of limbal tissue from related live donors successfully reconstructs the corneal surface in HLA-matched recipients. Recurrence of vascularization on long-term follow-up probably results from inadequate stem cell transfer, immune-mediated stem cell damage, or both. Limbal allografting is best performed by transplanting the entire limbus from a cadaveric donor eye with systemic immunosuppression of the recipient, even if the donor is HLA-compatible.
报告来自人类白细胞抗原（HLA）匹配和不匹配的亲属活体供体的角膜缘移植治疗因化学烧伤和史蒂文斯-约翰逊综合征导致眼表疾病患者的结果。
回顾性、非对照病例系列。
8例患者（9只眼），其中严重化学烧伤7只眼，史蒂文斯-约翰逊综合征2只眼。
受体眼采用瘢痕组织切除术治疗。从HLA匹配的亲属活体供体（n = 7）和不匹配的供体（n = 2）进行上下角膜缘移植。所有受体均未使用全身性环孢素。
角膜表面上皮重建、无血管化恢复、眼部舒适度增加和视力提高。
平均观察期为17.2个月，7只眼（77.8%）可见表型上的角膜上皮、角膜表面血管化减少和眼部舒适度改善。在所有7只眼中，随访期间周边角膜血管化逐渐复发。这7只眼中有3只眼（42.9%）出现了移植排斥特征。在2只眼中，来自HLA不匹配供体的角膜缘移植未能重建角膜表面。在最后一次随访时，角膜缘移植仅使2只眼（22.2%）的视力达到20/400或更好。在2只眼中，成功的角膜缘移植术后7个月和16个月进行的角膜移植出现了复发性上皮破损和角膜浅层瘢痕形成。本研究中所有供体眼均无任何并发症。
来自亲属活体供体的角膜缘组织移植成功地在HLA匹配的受体中重建了角膜表面。长期随访中血管化复发可能是由于干细胞转移不足、免疫介导的干细胞损伤或两者兼而有之。即使供体与HLA相容，角膜缘移植最好通过移植来自尸体供体眼的整个角膜缘并对受体进行全身性免疫抑制来进行。
