Iyer Geetha, Srinivasan Bhaskar, Agarwal Shweta, Tarigopula Anil
CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.
Molecular Diagnostic Laboratory & Transplantation Immunology, Apollo Hospitals, Chennai, Tamil Nadu, India.
Br J Ophthalmol. 2017 Jun;101(6):828-833. doi: 10.1136/bjophthalmol-2016-309045. Epub 2016 Oct 8.
To analyse the outcome of allo simple limbal epithelial transplantation (alloSLET) in eyes in the early stage following ocular chemical injury to achieve rapid epithelialisation.
Records of 18 eyes of 17 patients who underwent alloSLET between April 2013 and Jan 2016 were analysed retrospectively. Patients with grade 4 or worse Dua's classification for chemical injury, who presented within a month of the injury or with a non-healing epithelial defect since the injury despite earlier medical or surgical interventions, were included in the study. The time to epithelialisation was the primary outcome measure and the best corrected visual acuity, the clinically assessed epithelial phenotype and symblepharon formation were the secondary outcome measures.
The mean time to epithelialisation was noted to be 22.5±9.14 days. A best corrected visual acuity of better than 20/120 was achieved in 13 eyes in a mean duration of 33.06+10.73 days following alloSLET. Corneal phenotype with complete epithelialisation was achieved in the immediate postoperative period in 17 of the 18 eyes (94.11%). Seven eyes had a gradual failure of the allograft and 5 eyes underwent subsequent limbal autograft. Symblepharon formation involving one to two quadrants was noted in 3 eyes (16.7%).
AlloSLET seems to be a useful technique to achieve rapid epithelialisation in severe chemical injuries thereby preventing the adverse effects of delayed epithelial healing. Visual rehabilitative procedures in the chronic phase of chemical injury, in most instances following an alloSLET in the acute stage, did not require keratoplasty, either lamellar or penetrating.
分析在眼部化学伤早期进行同种异体单纯角膜缘上皮移植（alloSLET）以实现快速上皮化的效果。
回顾性分析2013年4月至2016年1月期间接受alloSLET的17例患者的18只眼的记录。纳入标准为化学伤达杜阿分级4级或更严重，在伤后1个月内就诊，或伤后虽经早期药物或手术干预但上皮缺损仍未愈合的患者。上皮化时间为主要观察指标，最佳矫正视力、临床评估的上皮表型和睑球粘连形成情况为次要观察指标。
上皮化平均时间为22.5±9.14天。alloSLET后平均33.06 + 10.73天，13只眼的最佳矫正视力达到20/120以上。18只眼中有17只（94.11%）在术后即刻实现了角膜完全上皮化的表型。7只眼的同种异体移植逐渐失败，5只眼随后接受了角膜缘自体移植。3只眼（16.7%）出现累及一至两个象限的睑球粘连。
alloSLET似乎是一种在严重化学伤中实现快速上皮化的有用技术，从而预防上皮愈合延迟的不良影响。在化学伤慢性期的视觉康复手术，在大多数情况下，在急性期进行alloSLET后，不需要进行板层或穿透性角膜移植术。
