Sangwan Virender S, Matalia Himanshu P, Vemuganti Geeta K, Ifthekar Ghazala, Fatima Anees, Singh Shashi, Rao Gullapalli N
Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, Cornea and Anterior Segment Service, L V Prasad Eye Institute, Hyderabad, India.
Arch Ophthalmol. 2005 Mar;123(3):334-40. doi: 10.1001/archopht.123.3.334.
To describe the early results of penetrating keratoplasty (PKP) in patients who had previously undergone cultivated limbal epithelium transplantation.
Medical records of patients with limbal stem cell deficiency due to chemical burns who underwent PKP after cultivated limbal epithelium transplantation were reviewed for demographics, primary etiology, type of limbal transplantation, ocular surface stability, visual acuity, graft clarity, and complications. Histopathologic features of the recipient corneal buttons were studied with special attention to epithelial status.
Of the 125 patients with limbal stem cell deficiency treated with cultivated limbal epithelium transplantation, 15 underwent PKP at a mean interval of 7 months (range, 2-12 months) following cultivated limbal epithelium transplantation (autologous, n = 11; allogenic, n = 4). All 4 patients treated with allogenic cultivated limbal epithelium transplantation were undergoing immunosuppressive therapy. Fourteen (93%) of the 15 eyes had a successful corneal graft with a stable corneal epithelium. Preoperative best-corrected visual acuity was less than 20/200 in 14 of the 15 eyes. At a mean +/- SD follow-up of 8.3 +/- 5.0 months after PKP, the best-corrected visual acuity was more than 20/60 in 8 eyes, 20/200 to 20/60 in 5 eyes, and less than 20/200 in 2 eyes. Three of the 15 eyes experienced corneal allograft rejection, which was managed successfully. One eye with graft rejection also had glaucoma. None of the limbal epithelial allografts showed signs of rejection.
Early results of PKP following cultivated limbal epithelium transplantation are favorable when performed after stabilizing the ocular surface. Adequate immunosuppression is essential for allogenic cultivated limbal epithelium transplantation to avoid rejection. Corneal allografts can separately reject the limbal allografts.
描述穿透性角膜移植术（PKP）在先前接受培养角膜缘上皮移植患者中的早期结果。
回顾因化学伤导致角膜缘干细胞缺乏且在培养角膜缘上皮移植后接受PKP患者的病历，记录人口统计学资料、主要病因、角膜缘移植类型、眼表稳定性、视力、植片清晰度及并发症。对受体角膜植片的组织病理学特征进行研究，特别关注上皮状态。
在125例接受培养角膜缘上皮移植治疗的角膜缘干细胞缺乏患者中，15例在培养角膜缘上皮移植后平均7个月（范围2 - 12个月）接受了PKP（自体移植，n = 11；异体移植，n = 4）。所有4例接受异体培养角膜缘上皮移植的患者均接受免疫抑制治疗。15只眼中有14只（93%）角膜植片成功，角膜上皮稳定。15只眼中有14只术前最佳矫正视力低于20/200。PKP后平均随访8.3±5.0个月时，8只眼最佳矫正视力大于20/60，5只眼为20/200至20/60，2只眼低于20/200。15只眼中有3只发生角膜同种异体移植排斥反应，但均成功处理。1只发生移植排斥反应的眼还患有青光眼。角膜缘上皮异体移植均未出现排斥迹象。
在眼表稳定后进行培养角膜缘上皮移植后的PKP早期结果良好。充分的免疫抑制对于异体培养角膜缘上皮移植避免排斥至关重要。角膜同种异体移植可单独排斥角膜缘异体移植。
