Weinberg David A, Tham Vivien, Hardin Nicholas, Antley Catherine, Cohen Adam J, Hunt Kerry, Glasgow Ben J, Baylis Henry I, Shorr Norman, Goldberg Robert Alan
Ophthalmic Plastic Surgery Service, Division of Ophthalmology, Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
Ophthalmic Plast Reconstr Surg. 2007 May-Jun;23(3):211-6. doi: 10.1097/IOP.0b013e318050d2d1.
To histologically evaluate the outcome of mucous membrane grafts to the eyelid.
Case series of 31 eyes from 24 patients who underwent transplantation of hard palate (25 eyes), buccal (1 eye), or nasal turbinate (5 eyes) mucosa to the posterior eyelid surface. These grafts were biopsied at 0.5 months to 84 months (mean, 20 months) postoperatively. They were examined with light microscopy and compared with either the donor mucosa from the same patient (2 patients) or the typical donor site histology (22 patients).
Graft biopsies revealed general epithelial morphology that was quite similar to the respective donor sites in virtually all cases. Six (25%) of 24 hard palate graft biopsies, which were obtained at 8 months to 49 months (mean, 22 months) postoperatively, displayed orthokeratosis alternating with parakeratosis, while 12 (50%) demonstrated parakeratosis alone, and another 6 (25%) showed adjacent regions of parakeratotic and nonkeratinized epithelium. No hard palate grafts showed complete absence of keratinization after transplantation. Other significant findings included loss of goblet cells in nasal turbinate grafts and few submucosal glands remaining in any specimen.
Full-thickness mucosal grafts typically maintain their native epithelial morphology following transplantation to the ocular surface. Submucosal glands usually do not survive transplantation, which could be the result of intentional thinning of the graft at the time of transplantation. Contrary to the opinion that hard palate graft epithelium usually undergoes metaplasia from keratinized to nonkeratinized within 6 months following transplantation to the eye, all hard palate grafts in this study remained orthokeratotic and/or parakeratotic.
通过组织学方法评估眼睑黏膜移植的效果。
对24例患者的31只眼进行病例系列研究，这些患者接受了硬腭黏膜移植（25只眼）、颊黏膜移植（1只眼）或鼻甲黏膜移植（5只眼）至眼睑后表面。这些移植物在术后0.5个月至84个月（平均20个月）进行活检。采用光学显微镜检查，并与同一患者的供体黏膜（2例患者）或典型的供体部位组织学（22例患者）进行比较。
移植物活检显示，几乎在所有病例中，一般上皮形态与各自的供体部位非常相似。24例硬腭移植物活检中有6例（25%）在术后8个月至49个月（平均22个月）显示正角化与不全角化交替出现，12例（50%）仅显示不全角化，另外6例（25%）显示不全角化和非角化上皮相邻区域。没有硬腭移植物在移植后显示完全无角化。其他重要发现包括鼻甲移植物中杯状细胞缺失，以及任何标本中残留的黏膜下腺很少。
全层黏膜移植物移植到眼表后通常保持其原有的上皮形态。黏膜下腺通常在移植后无法存活，这可能是移植时有意将移植物变薄的结果。与硬腭移植物上皮在移植到眼内后6个月内通常从角化转变为非角化的观点相反，本研究中的所有硬腭移植物均保持正角化和/或不全角化。
