Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube Straße 40, 06120, Halle, Germany.
Int Ophthalmol. 2022 Dec;42(12):3749-3762. doi: 10.1007/s10792-022-02373-8. Epub 2022 Aug 19.
Limbal stem cell deficiency (LSCD) is a rare but extremely relevant disease of the eye. LSCD patients often require a variety of surgical procedures, including keratoplasty in some cases. However, the outcome of these surgeries, including opacification and revascularization, is often frustrating due to LSCD relapse.
We developed a new surgical technique for the treatment of LSCD in which partial allogenic limbal transplantation (ALT) is carried out as part of penetrating keratoplasty (PK). After the PK, 1-8 slices from the limbal tissue of the donor graft are prepared and placed under the double running sutures attaching the corneal graft. This procedure was performed on 14 patients with LSCD, caused by severe ocular burn in 5 cases and by infection in 9. Between one and eight limbal transplants were used depending on the extension of the LSCD.
All 14 patients showed stable or increased visual acuity after the ALT surgery compared to their preoperative visual acuity. All of the grafts were integrated into the superficial corneal layers without progression of corneal vascularization beyond the limbal grafts. The median follow-up period was 12 months on average.
The ALT method seems to be a promising surgical procedure for the treatment of patients with LSCD. It can be properly carried out in the context of keratoplasty and does not require a separate donor tissue. The ALT grafts may offer the possibility of constructing a new limbal region, resulting in stable or even increased visual acuity and the absence of corneal vascularization.
边缘干细胞缺乏症（LSCD）是一种罕见但极其相关的眼部疾病。LSCD 患者通常需要进行各种手术，包括在某些情况下进行角膜移植。然而，由于 LSCD 复发，这些手术的结果，包括混浊和再血管化，往往令人沮丧。
我们开发了一种新的治疗 LSCD 的手术技术，其中部分同种异体边缘移植（ALT）作为穿透性角膜移植（PK）的一部分进行。在 PK 之后，从供体移植物的边缘组织中制备 1-8 个切片，并置于附着角膜移植物的双运行缝线下方。这项手术在 14 名 LSCD 患者中进行，其中 5 例由严重眼部烧伤引起，9 例由感染引起。根据 LSCD 的扩展范围，使用了 1-8 个边缘移植物。
与术前视力相比，所有 14 名患者在接受 ALT 手术后的视力均稳定或提高。所有移植物都整合到浅层角膜层中，角膜血管化没有超出边缘移植物的进展。中位随访时间平均为 12 个月。
ALT 方法似乎是治疗 LSCD 患者的一种有前途的手术方法。它可以在角膜移植的背景下适当地进行，不需要单独的供体组织。ALT 移植物可能提供构建新的边缘区域的可能性，从而导致稳定甚至提高视力，并且不存在角膜血管化。
