Division of Ophthalmology and Visual Sciences, University of Nottingham, England.
Ophthalmology. 2010 Jun;117(6):1207-13. doi: 10.1016/j.ophtha.2009.10.028. Epub 2010 Feb 16.
To evaluate the long-term results of limbal stem cell transplantation (LSCT) in patients with ocular surface (OS) disease.
Retrospective consecutive cohort study.
Case records of 27 eyes of 26 patients (19 males and 7 females) who presented with unilateral or bilateral total limbal stem cell deficiency and treated at the Department of Ophthalmology were examined.
All eyes that were treated with LSCT and that had at least 1 year follow-up were included. There were 12 autolimbal and 15 allolimbal transplants. Of the latter, 9 were from living related donors (LRDs) and 6 were from cadaver donors (CDs). A total of 9 eyes underwent LSCT and penetrating keratoplasty (PKP), and 11 eyes underwent LSCT and amniotic membrane transplantation (AMT). Cataract extraction with implant was carried out in 4 eyes. Some eyes had more than 1 associated procedure. Nine eyes had LSCT only. Patients with allolimbal transplants also received systemic immunosuppression.
Surgical success was measured by the duration for which a healthy corneal epithelium was maintained after LSCT. Visual success was measured by improvement in visual acuity (VA) in the operated eye during the follow-up period.
The follow-up period of all eyes was up to 119 months (mean 38+/-35.9 months, median 24 months). Survival of LSCT, as determined by the maintenance of healthy corneal epithelium until last follow-up, was seen in 22 eyes (82%). The surface failed within 3 months in 4 eyes (1 with LRD and 3 with CD) and after 43 months in the fifth patient (with CD). Subsequently, 6 eyes required PKP to achieve their maximum visual potential. The VA (measured in decimal fraction) improved over a period of 1 year from a mean of 0.121 (standard deviation [SD] 0.184) preoperatively to a mean of 0.313 (SD 0.348) postoperatively.
Limbal stem cell transplantation, in isolation or in combination with other procedures, is effective in improving corneal clarity and vision. Autografts have the best long-term outcome followed by LRD allografts. Cadaver donor allografts have a comparatively poor outcome. This may partly reflect the difference in case mix between unilateral and bilateral OS conditions.
评估眼表疾病患者进行角膜缘干细胞移植（LSCT）的长期效果。
回顾性连续队列研究。
检查了在眼科就诊的 26 名患者（19 名男性和 7 名女性）的 27 只单侧或双侧全角膜缘干细胞缺陷的病例记录。
纳入所有接受 LSCT 治疗且随访时间至少 1 年的患者。其中 12 只为自体角膜缘移植，15 只为同种异体角膜缘移植。后者中，9 例来自活体相关供体（LRD），6 例来自尸体供体（CD）。9 只眼行 LSCT 联合穿透性角膜移植术（PKP），11 只眼行 LSCT 联合羊膜移植术（AMT）。4 只眼行白内障摘除联合人工晶状体植入术。部分患者接受了 1 种以上的联合治疗。9 只眼仅行 LSCT。同种异体角膜缘移植患者还接受了全身免疫抑制治疗。
通过 LSCT 后健康角膜上皮维持的时间来衡量手术成功，通过随访期间手术眼视力（VA）的改善来衡量视力成功。
所有患者的随访时间最长达 119 个月（平均 38+/-35.9 个月，中位数 24 个月）。以最后一次随访时健康角膜上皮的维持情况来判断，LSCT 存活 22 只眼（82%）。4 只眼（1 例 LRD 和 3 例 CD）在 3 个月内，1 只眼（CD）在 43 个月后出现表面失败。随后，6 只眼需要行 PKP 以达到最大视力潜能。VA（以十进制分数表示）在 1 年内从术前平均 0.121（标准差 [SD] 0.184）提高到术后平均 0.313（SD 0.348）。
LSCT 单独或与其他手术联合应用可有效改善角膜透明度和视力。自体移植物的长期效果最好，其次是 LRD 同种异体移植物。尸体供体同种异体移植物的效果较差。这可能部分反映了单侧和双侧眼表疾病患者之间病例组合的差异。
