Sharma Namrata, Venugopal Renu, Mohanty Sujata, Priyadarshini K, Nagpal Ritu, Singhal Deepali, Bari Aafreen, Dada Tanuj, Maharana Prafulla Kumar, Agarwal Tushar, Upadhyay Ashish Dutt
Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Ocul Surf. 2024 Oct;34:504-509. doi: 10.1016/j.jtos.2024.10.007. Epub 2024 Oct 21.
To compare the outcomes of simple limbal epithelial transplantation (SLET) with cultivated limbal epithelial transplantation (CLET) for the management of total limbal stem cell deficiency (LSCD) in eyes with unilateral ocular burns.
Randomized controlled trial.
100 patients (100 eyes) with unilateral total LSCD following ocular burns undergoing autologous Limbal Stem Cell Transplantation (LSCT) were enrolled and randomized into SLET and CLET groups. Restoration of an epithelized ocular surface was the primary outcome measure. Occurrences of progressive conjunctivalization and persistent epithelial defects postoperatively were considered surgical failures.
Mean age was 20.2 ± 13.1 years (SLET) and 22.6 ± 14.3 years (CLET) (p = 0.363). Alkali burn was the most common causative factor in both groups and had comparable mean logMAR BCVA at presentation [SLET: 2.33 ± 0.5, CLET: 2.23 ± 1.48 (p = 0.652)]. Median time interval between injury and surgical intervention was 18 months (SLET) and 12 months (CLET) (p = 0.06). 88 % eyes in SLET group maintained a stable ocular surface at 1 year period versus CLET group (86 %) (p = 0.999). Mean logMAR BCVA significantly improved in both groups with SLET having significantly better BCVA versus CLET at 6 months (p = 0.0390), 1 year (p = 0.0001), 2 year (p = 0.0001) and 3 years (p = 0.0001) follow up. Kaplan-Meier survival analysis was statistically insignificant amongst the 2 groups (p = 0.590).
Compared to CLET, SLET is equally efficacious in restoring and maintaining a stable ocular surface in eyes with total LSCD due to ocular burns, with the added advantage of providing superior visual outcomes.
比较单纯角膜缘上皮移植（SLET）与培养角膜缘上皮移植（CLET）治疗单侧眼烧伤所致全角膜缘干细胞缺乏（LSCD）的疗效。
随机对照试验。
100例（100眼）单侧眼烧伤后发生全LSCD并接受自体角膜缘干细胞移植（LSCT）的患者被纳入研究，并随机分为SLET组和CLET组。眼表上皮化的恢复是主要结局指标。术后进行性结膜化和持续性上皮缺损的发生被视为手术失败。
SLET组平均年龄为20.2±13.1岁，CLET组为22.6±14.3岁（p = 0.363）。两组中碱烧伤均为最常见的致病因素，就诊时平均logMAR BCVA具有可比性[SLET组：2.33±0.5，CLET组：2.23±1.48（p = 0.652）]。受伤至手术干预的中位时间间隔为18个月（SLET组）和12个月（CLET组）（p = 0.06）。SLET组88%的眼在1年时维持稳定的眼表，CLET组为86%（p = 0.999）。两组平均logMAR BCVA均显著改善，SLET组在6个月（p = 0.0390）、1年（p = 0.0001）、2年（p = 0.0001）和3年（p = 0.0001）随访时的BCVA显著优于CLET组。两组间Kaplan-Meier生存分析无统计学意义（p = 0.590）。
与CLET相比，SLET在恢复和维持眼烧伤所致全LSCD患者稳定眼表方面同样有效，且具有提供更好视觉效果的额外优势。
