Witt J, Møller-Hansen M, Borrelli M, Holtmann C, Heegaard S, Geerling G
Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
Klinik für Augenheilkunde, Rigshospitalet-Glostrup, Universität Kopenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Dänemark.
Ophthalmologie. 2022 Sep;119(9):878-890. doi: 10.1007/s00347-022-01643-1. Epub 2022 Jun 28.
Restoration of eyelid and lacrimal functions are important steps on the way to an intact ocular surface. Clinically available substitute tissues or therapeutic options for eyelid reconstruction and lacrimal gland regeneration often reach their limits in patients with severe diseases of the adnexa oculi. Several approaches in regenerative medicine have been intensively researched and clinically tested in recent years. These range from reconstructive approaches with novel tissue matrices in the field of eyelid surgery to stem cell therapies to regenerate lacrimal gland function.
The state of the art in the current literature is presented and an overview of clinically applied or currently researched tissues for eyelid reconstruction is given. Furthermore, approaches in stem cell therapy of the lacrimal gland as well as own results are presented.
Acellular dermis has been successfully used for eyelid reconstruction and represents a viable option in cases of limited availability of autologous tissue. In vitro grown cellular constructs or tissues with genetically modified cells have already been successfully applied in dermatology for the treatment of burns or severe genodermatoses. First studies on stem cell therapy for severe dry eye in Sjögren syndrome showed a safe and effective application of mesenchymal stem cells by injection into the lacrimal gland.
Due to the limitations of currently available replacement tissues, there is a clinical need for the development of new materials for adnexa oculi reconstruction. Constructs grown in vitro with allogeneic and/or genetically engineered cells are slowly making their way into clinical practice. The efficacy and mode of action of stem cells in severe dry eye are subject matters of current clinical trials.
眼睑和泪腺功能的恢复是实现完整眼表的重要步骤。临床上用于眼睑重建和泪腺再生的替代组织或治疗选择，在患有严重眼附属器疾病的患者中常常受限。近年来，再生医学的几种方法得到了深入研究和临床测试。这些方法涵盖从眼睑手术领域使用新型组织基质的重建方法到用于恢复泪腺功能的干细胞疗法。
介绍当前文献中的最新技术，并概述临床上用于眼睑重建的已应用或正在研究的组织。此外，还介绍了泪腺干细胞治疗的方法以及自身的研究结果。
脱细胞真皮已成功用于眼睑重建，在自体组织供应有限的情况下是一种可行的选择。体外培养的细胞构建体或带有基因修饰细胞的组织已在皮肤科成功应用于治疗烧伤或严重遗传性皮肤病。针对干燥综合征严重干眼症的干细胞治疗的初步研究表明，通过向泪腺注射间充质干细胞的应用是安全有效的。
由于目前可用替代组织的局限性，临床上需要开发用于眼附属器重建的新材料。用同种异体和/或基因工程细胞体外培养的构建体正逐渐进入临床实践。干细胞在严重干眼症中的疗效和作用方式是当前临床试验的主题。
