Koizumi N, Inatomi T, Suzuki T, Sotozono C, Kinoshita S
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ophthalmology. 2001 Sep;108(9):1569-74. doi: 10.1016/s0161-6420(01)00694-7.
To investigate the outcome of cultivated corneal epithelial transplantation for severe stem cell deficiencies using denuded amniotic membrane (AM) as a carrier.
Retrospective, noncomparative case series.
Thirteen eyes of 11 patients were studied. These consisted of five eyes with acute Stevens-Johnson syndrome (SJS), two with chronic SJS, one with an acute chemical injury, two with chronic chemical injuries, two with ocular cicatricial pemphigoid, and one with drug-induced pseudopemphigoid. All of these eyes had total stem cell deficiencies.
Adaptation of the cultivated corneal epithelium onto the host corneal surface was confirmed 48 hours after surgery. The reconstruction of the ocular surface and visual acuity were measured.
Corneal limbal epithelium from donor corneas was cultivated for 4 weeks on a denuded AM carrier, with 3T3 fibroblast coculture and air lifting. The cultivated corneal epithelium showed four to five layers of stratification and was well differentiated. After conjunctival tissue removal from the cornea up to 3 mm outside the limbus and subconjunctival tissue treatment with 0.04% mitomycin C, cultivated allocorneal epithelium, including the AM carrier, was transplanted onto the corneal surface up to the limbus. Lamellar keratoplasty, using preserved donor graft without epithelium, was performed simultaneously for five chronic-phase patients showing corneal stromal scarring. Systemic immunosuppression was used to prevent allograft rejection.
In all 13 eyes, the entire corneal surface, on which cultivated allocorneal epithelium had been placed, was free from epithelial defects 48 hours after surgery, indicating complete survival of the transplanted corneal epithelium. Visual acuity improved in all eyes after surgery, and 10 of the 13 eyes were restored to good vision (postoperative visual acuity improved two or more lines) 6 months after the operation. During the follow-up period (mean +/- standard deviation, 11.2 +/- 1.3 months), the corneal surfaces were clear, although three eyes experienced epithelial rejection.
Cultivated corneal epithelial transplantation using denuded AM as a carrier can be used for severe stem cell deficiencies.
探讨以裸露羊膜（AM）为载体的培养角膜上皮移植治疗严重干细胞缺陷的效果。
回顾性、非对照病例系列。
对11例患者的13只眼进行了研究。其中包括5只急性史蒂文斯-约翰逊综合征（SJS）眼、2只慢性SJS眼、1只急性化学伤眼、2只慢性化学伤眼、2只瘢痕性类天疱疮眼和1只药物性类天疱疮样皮炎眼。所有这些眼均存在全干细胞缺陷。
术后48小时确认培养的角膜上皮在宿主角膜表面的贴合情况。测量眼表重建情况及视力。
从供体角膜获取角膜缘上皮，在裸露的AM载体上与3T3成纤维细胞共培养4周，并进行气液界面培养。培养的角膜上皮呈现4至5层分层且分化良好。在角膜缘外3毫米范围内从角膜去除结膜组织并用0.04%丝裂霉素C处理结膜下组织后，将包括AM载体的培养异体角膜上皮移植到角膜表面直至角膜缘。对5例显示角膜基质瘢痕形成的慢性期患者同时进行了使用无上皮的保存供体移植物的板层角膜移植术。使用全身免疫抑制来预防同种异体移植排斥反应。
在所有13只眼中，术后48小时放置了培养异体角膜上皮的整个角膜表面均无上皮缺损，表明移植的角膜上皮完全存活。术后所有眼的视力均有提高，13只眼中有10只在术后6个月恢复到良好视力（术后视力提高两行或更多）。在随访期（平均±标准差，11.2±1.3个月）内，角膜表面清晰，尽管有3只眼发生了上皮排斥反应。
以裸露AM为载体的培养角膜上皮移植可用于严重干细胞缺陷。
