Maruyama-Hosoi Fumiko, Shimazaki Jun, Shimmura Shigeto, Tsubota Kazuo
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Cornea. 2006 May;25(4):377-82. doi: 10.1097/01.ico.0000176608.65708.27.
To study the incidence and clinical characteristics of presumed immunologic reactions in limbal grafts after keratolimbal allograft(KLAL).
A total of 121 KLALs performed in consecutive 85 eyes of 78 patients with total limbal stem-cell deficiency were analyzed retrospectively. Mean follow-up period was 46.6 months. Three types of limbal graft changes classified as epithelial defects, acute edema, and vascular engorgement were analyzed as probable signs of immunologic rejection.
One or more changes in limbal grafts were observed after 16 KLALs (13.1%). All but 1 eye used systemic and local immunosuppression using corticosteroid and cyclosporine A, and most of the changes developed within 3 months postoperatively. All but 2 eyes developed epithelial breakdown in the central cornea, and 12 corneas underwent conjunctivalization. The rate of corneal epithelialization in eyes with limbal graft changes was significantly worse than those without the changes (P < 0.0001). Histologic examination in eyes with the limbal graft changes revealed high incidence of lymphocyte infiltration.
Presumed limbal graft rejection occurred in approximately 13% of cases after KLAL. Suppression of the immune reaction remains a key to success in KLAL.
研究角膜缘移植术后角膜缘移植物推测性免疫反应的发生率及临床特征。
回顾性分析78例全角膜缘干细胞缺乏患者的85只眼连续进行的121例角膜缘移植术。平均随访时间为46.6个月。将角膜缘移植物的三种变化分类为上皮缺损、急性水肿和血管充血，作为免疫排斥反应的可能体征进行分析。
16例（13.1%）角膜缘移植术后观察到角膜缘移植物有一处或多处变化。除1只眼外，所有眼睛均使用全身和局部免疫抑制剂，即皮质类固醇和环孢素A，且大多数变化发生在术后3个月内。除2只眼外，所有眼睛中央角膜均出现上皮破损，12只角膜发生结膜化。有角膜缘移植物变化的眼睛角膜上皮化率明显低于无变化的眼睛（P<0.0001）。对有角膜缘移植物变化的眼睛进行组织学检查发现淋巴细胞浸润发生率高。
角膜缘移植术后约13%的病例发生推测性角膜缘移植物排斥反应。抑制免疫反应仍然是角膜缘移植成功的关键。
