Cheng J, Wang J Y, Duan H Y, Wang S, Cong L, Xie L X
Qingdao Eye Hospital, Shandong Eye Institute, Qingdao 266071, China.
Zhonghua Yan Ke Za Zhi. 2017 Mar 11;53(3):172-176. doi: 10.3760/cma.j.issn.0412-4081.2017.03.005.
To introduce the surgical methods and investigate the treatment effects of conjunctival lesion resection combined with transplantation of allogeneic limbal epithelia cultured in vitro for treatment of varied large conjunctival lesions. A retrospective analysis of case data of the patients receiving transplantation of allogeneic limbal epithelia cultured in vitro for large conjunctival lesions at Qingdao Eye Hospital from January 2013 to December 2015 was conducted. Fresh donor corneal limbal epithelial tissues were obtained for cellular digestion and isolation. The cells were cultured on de-epithelized amniotic membrane to form a stratified cell sheet with 3 to 5 layers of cells for reservation. Conjunctival lesions were removed, and corneal limbal epithelial cell sheets corresponding to the size of the conjunctival defects were covered on the scleral flaps, before the conjunctivae were para sutured with corneal limbal epithelial cell sheets. The stitches were removed 7 days after surgery. The treatment effects were evaluated. There were 11 cases (12 eyes) in this study, including 6 cases (6 eyes) of recurrent pterygium combined with symblepharon, 3 cases (3 eyes) of conjunctival compound nevus, 1 case (1 eye) of conjunctival primary acquired melanosis, and 1 case (2 eyes) of dermoid lipoma. The patients were 6 to 69 years old, with an average age of (46±23) years old. There were 5 male patients and 6 female patients. The follow-up time was 6 to 39 months, with an average time of (24.8±12.4) months. The conjunctival lesions in all patients were more than 2 quadrants. No patients had intraoperative and postoperative complications. No obvious irritation symptoms were observed after surgery. There were a few small pieces of epithelial defects on the limbal epithelial cell sheets at the end of the operation due to operative injury. With postoperative cellular proliferation and repair, the epithelium gradually healed and tended to become firm, and the boundaries with original conjunctival epithelium gradually disappeared. The healing time of the epithelium after surgery was 3 to 7 days, with an average time of (4.5±1.2) days. No immunological rejection occurred after surgery. No recurrence of original diseases was observed among all the patients at the last follow-up. Transplantation of allogeneic cultured limbal epithelial cells, which was carried out for the treatment of large conjunctival lesions, witnessed rapid epithelization at the areas of lesion resection. It could reduce the risk of recurrence of original diseases and effectively avoid the occurrence of postoperative symblepharon. The postoperative inflammatory reaction was also minor. .
介绍结膜病变切除术联合体外培养的同种异体角膜缘上皮移植治疗各种大面积结膜病变的手术方法并探讨其治疗效果。对2013年1月至2015年12月在青岛眼科医院接受体外培养的同种异体角膜缘上皮移植治疗大面积结膜病变的患者病例资料进行回顾性分析。获取新鲜供体角膜缘上皮组织进行细胞消化和分离。将细胞接种于去上皮羊膜上培养形成3至5层细胞的分层细胞片备用。切除结膜病变，在巩膜瓣上覆盖与结膜缺损大小相应的角膜缘上皮细胞片，然后将结膜与角膜缘上皮细胞片间断缝合。术后7天拆线并评估治疗效果。本研究共11例（12眼），其中复发性翼状胬肉合并睑球粘连6例（6眼），结膜复合痣3例（3眼），结膜原发性获得性黑色素沉着1例（1眼），皮样脂肪瘤1例（2眼）。患者年龄6至69岁，平均年龄（46±23）岁。男性患者5例，女性患者6例。随访时间6至39个月，平均（24.8±12.4）个月。所有患者结膜病变均超过2个象限。无患者发生术中及术后并发症。术后未观察到明显刺激症状。手术结束时角膜缘上皮细胞片因手术损伤有少量小块上皮缺损。随着术后细胞增殖修复，上皮逐渐愈合且趋于牢固，与原结膜上皮边界逐渐消失。术后上皮愈合时间3至7天，平均（4.5±1.2）天。术后未发生免疫排斥反应。末次随访时所有患者原发病均无复发。体外培养的同种异体角膜缘上皮细胞移植治疗大面积结膜病变，病变切除区域上皮化迅速，可降低原发病复发风险，有效避免术后睑球粘连发生，术后炎症反应也较轻。
