Meallet Mario A, Espana Edgar M, Grueterich Martin, Ti Seng-Ei, Goto Eiki, Tseng Scheffer C G
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA.
Ophthalmology. 2003 Aug;110(8):1585-92. doi: 10.1016/S0161-6420(03)00503-7.
To evaluate the outcomes of corneal surface reconstruction with conjunctival limbal autograft when combined with amniotic membrane transplantation on both the donor and recipient eyes.
Retrospective, noncomparative, interventional small case series.
Five eyes of five patients with total limbal stem cell deficiency (LSCD) resulting from pseudopemphigoid (n = 1), chemical burns (n = 3), and extensive removal of conjunctival intraepithelial neoplasia (n = 1) were operated on by one surgeon (SCGT).
After the removal of fibrovascular pannus from the corneal surface, two conjunctival limbal free grafts were harvested from the fellow eyes in all five patients with unilateral LSCD. Amniotic membrane, with the basement membrane side up, was grafted onto the defect created at the donor site and onto the recipient corneal and limbal sclera before placement of conjunctival limbal grafts.
Symptomatic relief, improvement in visual acuity, fornix deepening, and rapid healing and restoration of normal cornea and limbus in the recipient and donor eyes were assessed.
During the mean follow-up of 22 months (range, 11-48 months), all eyes experienced symptomatic relief. All recipient eyes had a mean improvement in visual acuity of nine lines (range, 7-12). The three eyes with stromal vascularization showed regression, and all recipient eyes had marked improvement in corneal clarity. Three eyes receiving simultaneous symblepharon lysis and fornix reconstruction successfully regained deep, stable fornices. The donor eyes showed rapid healing and restoration of the normal limbal landmark, even in one eye where nearly the entire limbus was removed.
Limbal conjunctival transplantation is an effective procedure for restoring the corneal surface integrity in eyes with total LSCD. The additional use of amniotic membrane may contribute to a higher rate of success in the recipient eye and a lower rate of complications in the donor eye, as well as allow the simultaneous correction of concomitant cicatricial abnormalities.
评估自体结膜角膜缘移植联合羊膜移植于供体眼和受体眼进行角膜表面重建的效果。
回顾性、非对照、介入性小病例系列研究。
5例患者的5只眼，均因类天疱疮（1例）、化学伤（3例）和广泛切除结膜上皮内瘤变（1例）导致全角膜缘干细胞缺乏（LSCD），由同一位外科医生（SCGT）进行手术。
从角膜表面清除纤维血管性 pannus 后，所有5例单侧 LSCD 患者均从对侧眼获取两片游离结膜角膜缘移植片。在放置结膜角膜缘移植片之前，将基底膜面朝上的羊膜移植到供体部位形成的缺损处以及受体角膜和角膜缘巩膜上。
评估症状缓解情况、视力改善情况、穹窿加深情况以及受体眼和供体眼中角膜和角膜缘的快速愈合及恢复正常情况。
在平均22个月（范围11 - 48个月）的随访期间，所有眼均有症状缓解。所有受体眼的平均视力提高了9行（范围7 - 12行）。3只出现基质血管化的眼血管化情况消退，所有受体眼的角膜透明度均有明显改善。3只同时接受睑球粘连松解和穹窿重建的眼成功恢复了深而稳定的穹窿。供体眼显示出正常角膜缘标志的快速愈合和恢复，即使在1只几乎切除了整个角膜缘的眼中也是如此。
角膜缘结膜移植是恢复全 LSCD 眼角膜表面完整性的有效方法。额外使用羊膜可能有助于提高受体眼的成功率、降低供体眼的并发症发生率，并能同时矫正伴随的瘢痕性异常。
