Prabhasawat Pinnita, Luangaram Angkoon, Ekpo Pattama, Lekhanont Kaevalin, Tangpagasit Wimolwan, Boonwong Chawikan, Inthasin Naharuthai, Chirapapaisan Chareenun
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Cell Tissue Bank. 2019 Mar;20(1):95-108. doi: 10.1007/s10561-018-09746-3. Epub 2019 Jan 24.
Simple limbal epithelial transplantation (SLET) is a relatively new treatment for severe limbal stem cell deficiency. Outcomes of treatment are typically determined based on clinical manifestations. In this prospective-multicenter study, we aimed to analyze the epithelial phenotypes of the corneas after SLET using IVCM and IC, and correlated them with clinical findings. Ten eyes of nine patients, who underwent SLET (five autologous SLET and five living-related SLET) were recruited. A set of examinations included slit-lamp biomicroscopy, corneal in vivo confocal microscopy (IVCM), and impression cytology (IC) was performed in all eyes at least twice (≥ 3-month interval) postoperatively. Then, a correlation between findings of the three examinations was analyzed. There were seven eyes with clinical success (no central neovascularization) showed pure corneal epithelial phenotype or mixed corneal-conjunctival phenotypes (mostly cornea) in either IVCM or IC. Three eyes with clinical failure, presented with peripheral and central neovascularization, showed total or predominant conjunctival phenotype in IVCM and sole conjunctival phenotype in IC. From a total of 22 sets of examinations, there was a high correlation between clinical manifestation vs. IC (κ = 0.844, observed agreement = 81.82%) and a substantial correlation between clinical manifestation vs. IVCM (κ = 0.727, observed agreement = 76.19%) and between IVCM versus IC (κ = 0.729, observed agreement = 76.19%). In conclusion, IVCM and IC facilitate determination of epithelial phenotype of the cornea after SLET. There was a substantial to high correlation between IVCM, IC and clinical presentations. Findings observed by IVCM and IC may allow early detection of epithelial alterations in eyes underwent SLET before clinical recognition.
单纯角膜缘上皮移植术（SLET）是一种针对严重角膜缘干细胞缺乏症的相对较新的治疗方法。治疗结果通常根据临床表现来确定。在这项前瞻性多中心研究中，我们旨在使用活体共聚焦显微镜（IVCM）和印迹细胞学（IC）分析SLET术后角膜的上皮表型，并将其与临床结果相关联。招募了9例接受SLET的患者的10只眼（5例自体SLET和5例活体亲属供体SLET）。所有眼睛在术后至少两次（间隔≥3个月）进行了一系列检查，包括裂隙灯生物显微镜检查、角膜活体共聚焦显微镜检查（IVCM）和印迹细胞学检查（IC）。然后，分析了这三项检查结果之间的相关性。7只临床成功（无中央新生血管形成）的眼睛在IVCM或IC中显示为单纯角膜上皮表型或混合角膜-结膜表型（主要为角膜）。3只临床失败且出现周边和中央新生血管形成的眼睛在IVCM中显示为完全或主要结膜表型，在IC中显示为单一结膜表型。在总共22组检查中，临床表现与IC之间存在高度相关性（κ = 0.844，观察一致性 = 81.82%），临床表现与IVCM之间存在显著相关性（κ = 0.727，观察一致性 = 76.19%），IVCM与IC之间也存在显著相关性（κ = 0.729，观察一致性 = 76.19%）。总之，IVCM和IC有助于确定SLET术后角膜的上皮表型。IVCM、IC与临床表现之间存在显著到高度的相关性。IVCM和IC观察到的结果可能使我们能够在临床识别之前早期检测接受SLET的眼睛中的上皮改变。
