Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Ocul Surf. 2021 Oct;22:27-37. doi: 10.1016/j.jtos.2021.06.012. Epub 2021 Jun 30.
To evaluate the efficacy and outcome of simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD) using epithelial phenotype detection integrated with clinical manifestation.
This prospective multicenter study included patients with LSCD who underwent autologous SLET (autoSLET) and living-related allogenic SLET (Lr-alloSLET). All patients were assessed by slit-lamp biomicroscopy, in vivo confocal microscopy (IVCM), and impression cytology with immunofluorescence staining (ICIF) before and after surgery. The criteria for success were the presence of a clinically non-conjunctivalized cornea and corneal epithelium detected by IVCM or ICIF. Otherwise, the case would be considered a failure. Visual improvement and risk factors for SLET failure were analyzed.
A total of 28 eyes of 26 patients (11 autoSLET and 17 Lr-alloSLET) were included. The median age was 53 years (range, 35-63), and the follow-up time was 29.5 months (range, 17.5-39.8). The overall survival rate was 89.3% at 2 years and 75.6% at 3 years with no difference between autoSLET and Lr-alloSLET (p = 0.24). Seven eyes subsequently underwent penetrating keratoplasty. Immunohistochemistry analysis showed that all corneal buttons had corneal epithelium and limbal stem cell markers. Visual improvement was achieved in both SLET groups (p < 0.001). Failed SLET developed between 5 and 32 months postoperatively. However, absolute risk factors for SLET failure were unidentified.
The efficacy of autoSLET and Lr-alloSLET for LSCD was excellent. Limbal explants can regenerate and restore the corneal surface while maintaining the characteristics of limbal stem cells as shown by epithelial phenotype detection and immunohistochemistry integrated with clinical evaluation.
通过整合临床表现和上皮细胞表型检测，评估单纯性角膜缘上皮移植（SLET）治疗角膜缘干细胞缺乏症（LSCD）的疗效和结果。
本前瞻性多中心研究纳入了接受自体 SLET（autoSLET）和活体亲属同种异体 SLET（Lr-alloSLET）的 LSCD 患者。所有患者均在术前和术后通过裂隙灯生物显微镜、活体共聚焦显微镜（IVCM）和免疫荧光染色（ICIF）的印迹细胞学进行评估。成功的标准是存在临床非结膜化的角膜和 IVCM 或 ICIF 检测到的角膜上皮。否则，将视为失败。分析了 SLET 失败的视觉改善和危险因素。
共纳入 26 例患者的 28 只眼（11 只 autoSLET 和 17 只 Lr-alloSLET）。中位年龄为 53 岁（范围，35-63 岁），随访时间为 29.5 个月（范围，17.5-39.8 个月）。2 年时的总生存率为 89.3%，3 年时为 75.6%，autoSLET 和 Lr-alloSLET 之间无差异（p=0.24）。7 只眼随后接受了穿透性角膜移植。免疫组织化学分析显示所有角膜瓣均有角膜上皮和角膜缘干细胞标志物。两组 SLET 均实现了视力改善（p<0.001）。SLET 失败发生在术后 5 至 32 个月之间。然而，SLET 失败的绝对危险因素尚不清楚。
自体 SLET 和 Lr-alloSLET 治疗 LSCD 的疗效非常好。通过整合临床表现和上皮细胞表型检测以及免疫组织化学分析，发现角膜缘移植物可以再生并恢复角膜表面，同时保持角膜缘干细胞的特征。
