Parmar Dipak N, Alizadeh Hassan, Awwad Shady T, Li Haochuan, Neelam Sudha, Bowman R Wayne, Cavanagh H Dwight, McCulley James P
Division of Cornea, External Disease and Refractive Surgery, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
Am J Ophthalmol. 2006 Feb;141(2):299-307. doi: 10.1016/j.ajo.2005.09.008.
To assess the effect of tissue-cultured human amniotic epithelial cells (AECs) in restoring the ocular surface, transplanted using a collagen shield seeded with AECs supported by a soft contact lens.
Prospective interventional single-institutional case series with crossover controls.
Three eyes in three patients were identified with persistent corneal epithelial defects (PEDs) refractory to medical therapy. Two cases were secondary to neurotrophic keratopathy, while one case was attributable to longstanding alkali injury. AECs were isolated from serologically screened donor human placenta, seeded onto collagen corneal shields, and incubated in tissue culture medium for 7 days. These collagen shields were placed over the PED and supported by an overlying soft contact lens. The collagen shields dissolved by 72 hours, and the contact lenses were removed after this time. This cycle was repeated every week until healing was achieved. As a crossover control, collagen shields without AECs were placed in the same eye 1 week before placing collagen shields containing AECs. The PED was assessed by vital staining and slit-lamp color photography.
The PEDs had a mean duration of 4 months and involved 20% to 37% of the corneal surface area, one case secondary to longstanding alkali injury and two cases attributable to neurotrophic keratopathy. No change in PED size was observed in those control eyes receiving collagen shields without AECs. Complete resolution of the PED was seen after two cycles of AEC-seeded collagen shield in one case, and four cycles in two cases, from 7 to 12 weeks following treatment in all patients. No loss of visual acuity was seen and clinical improvement was maintained in all cases, with a mean follow-up of 6.3 months.
Nonsurgical transplantation of tissue-cultured AECs on a collagen shield provides a promising approach to restoring the ocular surface in cases of PED.
评估组织培养的人羊膜上皮细胞（AECs）在恢复眼表方面的效果，采用接种了AECs的胶原盾并由软性隐形眼镜支撑进行移植。
具有交叉对照的前瞻性干预单机构病例系列。
三名患者的三只眼睛被诊断为药物治疗无效的持续性角膜上皮缺损（PEDs）。两例继发于神经营养性角膜病变，一例归因于长期碱性损伤。从经过血清学筛查的供体人胎盘中分离出AECs，接种到胶原角膜盾上，并在组织培养基中培养7天。将这些胶原盾置于PED上，并由上方的软性隐形眼镜支撑。胶原盾在72小时内溶解，此时移除隐形眼镜。每周重复此循环，直至愈合。作为交叉对照，在放置含AECs的胶原盾前1周，将不含AECs的胶原盾置于同一只眼中。通过活体染色和裂隙灯彩色摄影评估PED。
PED的平均持续时间为4个月，累及角膜表面积的20%至37%，一例继发于长期碱性损伤，两例归因于神经营养性角膜病变。在接受不含AECs的胶原盾的对照眼中，未观察到PED大小的变化。在所有患者治疗后7至12周，一例患者在接种AECs的胶原盾治疗两个周期后，两例患者在四个周期后，PED完全消退。所有病例均未出现视力丧失，且临床改善得以维持，平均随访6.3个月。
在胶原盾上非手术移植组织培养的AECs为恢复PED病例的眼表提供了一种有前景的方法。
