Meller D, Pauklin M, Westekemper H, Steuhl K-P
Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universität Duisburg-Essen, Essen, Germany.
Ophthalmologe. 2010 Dec;107(12):1133-8. doi: 10.1007/s00347-010-2205-9.
In this study the clinical outcome of ex vivo expansion of autologous limbal epithelial cells on intact amniotic membranes (AM) for ocular surface reconstruction in limbal stem cell deficiency (LSCD) was investigated.
A total of 30 eyes in 28 patients (22 male and 6 female) with total (n=18) or partial (n=12) LSCD were treated by transplantation of autologous limbal epithelial cells after expansion on intact AM. The causes of LSCD in the patients were chemical and thermal burns (n=16), pterygium (n=9), tumor excision (n=2), perforating injury, mitomycin C-induced LSCD and epidermolysis bullosa (each n=1). Only eyes with a follow-up time of at least 9 months were included in the analysis. The main outcome criteria were restoration of ocular surface integrity and improvement of visual acuity (VA).
The mean follow-up time was 28.9±15.5 months. An entirely stable corneal surface was reconstructed in 23 (76.7%) eyes. Visual acuity increased significantly in 21 (70%) eyes, was stable in 8 (26.7%) eyes and decreased in 1 (3.3%) eye. The mean visual acuity increased significantly (p<0.0001) from a preoperative value of 1.58±0.97 LogMAR to 0.6±0.49 LogMAR.
Transplantation of limbal epithelium cultivated on intact AM restores a stable corneal surface and results in a significant increase in visual acuity in most cases of LSCD. Autologous transplantation of cultivated limbal epithelium showed an excellent prognosis and outcome after long-term follow-up.
本研究旨在探讨在完整羊膜（AM）上自体角膜缘上皮细胞体外扩增用于角膜缘干细胞缺乏（LSCD）眼表重建的临床效果。
28例患者（22例男性，6例女性）共30只眼患有全层（n = 18）或部分（n = 12）LSCD，接受了在完整羊膜上扩增后的自体角膜缘上皮细胞移植治疗。患者LSCD的病因包括化学和热烧伤（n = 16）、翼状胬肉（n = 9）、肿瘤切除（n = 2）、穿孔伤、丝裂霉素C诱导的LSCD和大疱性表皮松解症（各n = 1）。分析仅纳入随访时间至少9个月的眼。主要结局标准为眼表完整性的恢复和视力（VA）的改善。
平均随访时间为28.9±15.5个月。23只眼（76.7%）重建了完全稳定的角膜表面。21只眼（70%）视力显著提高，8只眼（26.7%）视力稳定，1只眼（3.3%）视力下降。平均视力从术前的1.58±0.97 LogMAR显著提高（p<0.0001）至0.6±0.49 LogMAR。
在完整羊膜上培养的角膜缘上皮移植可恢复稳定的角膜表面，并在大多数LSCD病例中导致视力显著提高。培养的角膜缘上皮自体移植经长期随访显示出良好的预后和效果。
