Santos Myrna S, Gomes José A P, Hofling-Lima Ana Luisa, Rizzo Luiz V, Romano André C, Belfort Rubens
Cornea and External Disease Service, Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Am J Ophthalmol. 2005 Aug;140(2):223-30. doi: 10.1016/j.ajo.2005.03.022.
To evaluate the survival of conjunctival limbal grafts and amniotic membrane transplantation (AMT) for total limbal stem cell deficiency (LSCD) and the influence of several parameters as cause of LSCD, dry eye, keratinization, eyelid abnormalities, HLA compatibility, systemic immunosuppression, and keratoplasty (PKP) on surgical outcome.
Prospective, noncomparative, interventional case series.
Thirty-three eyes of 31 patients with total LSCD that underwent conjunctival limbal grafts and AMT at the Department of Ophthalmology, Federal University of São Paulo were included in this study. Cumulative graft survival as well as the influence of several variables on surgical outcome was analyzed.
Ten eyes (30%) underwent conjunctival limbal autograft and 23 (70%) underwent conjunctival limbal allograft from living HLA-matched donor. Graft survival was seen in 13 eyes (40%) at 1 year and in 11 eyes (33.3%) at 2 years, with a cumulative survival of 33% after a mean follow-up time of 33 months. Increase in postoperative visual acuity was observed in 20 eyes (60.6%) during this period. Marked impact on graft survival was observed for patients with Stevens-Johnson syndrome, dry eye, keratinization, eyelid abnormalities, and allogeneic conjunctival limbal transplantation (independently of HLA compatibility) (P < .05). Preoperative dry eye was the most important prognostic parameter for surgical outcome (P < .001).
Conjunctival limbal grafts associated with AMT are useful for restoring corneal epithelium phenotype in eyes with total LSCD. However, the cumulative survival declines substantially over a 2-year period. Considering all investigated variables, dry eye was the most important prognostic parameter.
评估结膜角膜缘移植联合羊膜移植（AMT）治疗完全性角膜缘干细胞缺乏（LSCD）的存活率，以及多种因素如LSCD病因、干眼、角膜角化、眼睑异常、HLA相容性、全身免疫抑制和角膜移植术（PKP）对手术效果的影响。
前瞻性、非对照、干预性病例系列研究。
本研究纳入了圣保罗联邦大学眼科接受结膜角膜缘移植联合AMT治疗的31例完全性LSCD患者的33只眼。分析了移植累积存活率以及多种变量对手术效果的影响。
10只眼（30%）接受了结膜角膜缘自体移植，23只眼（70%）接受了来自活体HLA匹配供体的结膜角膜缘异体移植。1年时13只眼（40%）移植存活，2年时11只眼（33.3%）移植存活，平均随访33个月后累积存活率为33%。在此期间，20只眼（60.6%）术后视力提高。观察到史蒂文斯-约翰逊综合征、干眼、角膜角化、眼睑异常以及异体结膜角膜缘移植（与HLA相容性无关）的患者对移植存活有显著影响（P < 0.05）。术前干眼是手术效果最重要的预后参数（P < 0.001）。
结膜角膜缘移植联合AMT对恢复完全性LSCD眼的角膜上皮表型有用。然而，2年内累积存活率显著下降。综合所有研究变量，干眼是最重要的预后参数。
