Ramaesh K, Dhillon B
Princess Alexandra Eye Pavilion, Edinburgh, UK.
Eur J Ophthalmol. 2003 Jul;13(6):515-24. doi: 10.1177/112067210301300602.
The management of severe ocular surface disease due to limbal stem cell deficiency has changed dramatically. The concept of limbal stem cells, as the source of corneal epithelium revolutionised the therapeutic approach of ocular surface reconstruction. Deficiency of limbal stem cells results in blinding ocular surface diseases. Grafting viable limbal tissue, from either fellow healthy eye or a donor eye, with the resident stem cell population may replenish limbal stem cells and can restore the corneal surface to normality. Transplanting the limbal tissue can be achieved through a variety of procedures that include cadaveric keratolimbal allograft (KLAL), live or living related conjunctival limbal allograft (Ir-CLAL) and limbal autograft. Advances in tissue engineering techniques have offered a viable alternative to overcome the limitation of limbal tissue available for transplantation. Epithelial stem cells harvested from a small limbal biopsy can be expanded in vitro on a suitable carrier and then transplanted to the diseased cornea to successfully restore the corneal surface. This article is a chronological review of the important steps that brought ex vivo expanded stem cell transplantation in ocular, particularly corneal surface reconstruction.
The MEDLINE data base was searched for the years 1966-2002, using key words cornea, cell culture, ex-vivo expansion, limbus, stem cell, ocular surface and transplantation. Several articles that were not found by MEDLINE search were taken from references from other articles. Inclusion or exclusion of article was based on the relevance to the subject.
Corneal epithelial reconstruction with ex vivo expanded limbal cells is a potential tool in ocular surface reconstruction, although the technique is currently investigational. Strategies to achieve conjunctival epithelial restoration and tear film replenishment will allow ophthalmic surgeons to truly reconstruct the ocular surface.
因角膜缘干细胞缺乏所致严重眼表疾病的治疗方法已发生了巨大变化。角膜缘干细胞作为角膜上皮细胞来源的概念彻底改变了眼表重建的治疗方法。角膜缘干细胞缺乏会导致致盲性眼表疾病。移植来自健侧眼或供体眼带有固有干细胞群体的活性角膜缘组织，可补充角膜缘干细胞并使角膜表面恢复正常。角膜缘组织移植可通过多种手术方式实现，包括尸体角膜缘移植（KLAL）、活体或亲属活体结膜角膜缘移植（Ir-CLAL）以及角膜缘自体移植。组织工程技术的进展为克服可用于移植的角膜缘组织的局限性提供了可行的替代方法。从小片角膜缘活检获取的上皮干细胞可在合适的载体上进行体外扩增，然后移植到患病角膜上，从而成功恢复角膜表面。本文按时间顺序回顾了将体外扩增干细胞移植用于眼部，尤其是角膜表面重建的重要步骤。
利用关键词角膜、细胞培养、体外扩增、角膜缘、干细胞、眼表和移植，检索了1966年至2002年期间的MEDLINE数据库。MEDLINE检索未找到的几篇文章取自其他文章的参考文献。文章的纳入或排除基于与主题的相关性。
尽管目前该技术仍处于研究阶段，但用体外扩增的角膜缘细胞进行角膜上皮重建是眼表重建的一种潜在手段。实现结膜上皮修复和泪膜补充的策略将使眼科医生能够真正重建眼表。
