Sundmacher R, Reinhard T, Althaus C
Augenklinik, Heinrich-Heine-Universität Düsseldorf.
Ophthalmologe. 1997 Dec;94(12):897-901. doi: 10.1007/s003470050218.
Problems with epithelial healing are the main cause of corneal graft failure in patients with limbal stem cell deficiency. This post-operative complication cannot be eliminated by conventional penetrating keratoplasty alone, but only by additional limbal grafting, which is, however, highly immunogenic. We report here our 3 years' experience with a new surgical procedure which we developed called homologous central limbokeratoplasty.
We have performed 52 homologous central limbo-keratoplasties in patients with limbal stem cell deficiency since February 1993. We report here the results of the first 18 transplantations with the longest follow-up periods (mean 22 months). The unmatched donor cornea was trephined in a way such that 40% of its circumference contained limbus. These grafts were then sutured centrally into the host cornea. Systemic cyclosporin A (CSA) was administered for at least 1 year after all transplantations.
Fourteen of the 18 grafts failed during the follow-up period. The reasons for graft failure were severe surface disorders (7), severe surface disorders in combination with endothelial immune reactions (5) and endothelial immune reactions alone (2). The four patients with centrally clear grafts no longer receive systemic CSA with follow-up periods between 20 and 30 months.
Central limbo-keratoplasty is a very promising procedure. However, the average results are not yet satisfying, because the majority of limbal stem cells undergo rejection within 2 years. Improved results will be achievable in the future by using well-matched instead of non-matched transplants and by further improving immune modulation beyond the effectiveness of current CSA treatment.
上皮愈合问题是角膜缘干细胞缺乏患者角膜移植失败的主要原因。这种术后并发症不能仅通过传统的穿透性角膜移植术消除，而只能通过额外的角膜缘移植来解决，然而，角膜缘移植具有高度免疫原性。我们在此报告我们开展的一项名为同种异体中央角膜缘移植术的新手术的3年经验。
自1993年2月以来，我们对角膜缘干细胞缺乏患者实施了52例同种异体中央角膜缘移植术。我们在此报告前18例移植手术的结果，这些患者的随访期最长（平均22个月）。将不匹配的供体角膜环切，使其圆周的40%包含角膜缘。然后将这些移植物在中央缝合到宿主角膜中。所有移植术后均全身应用环孢素A（CSA）至少1年。
18例移植物中有14例在随访期间失败。移植失败的原因包括严重的表面病变（7例）、严重表面病变合并内皮免疫反应（5例）以及单纯内皮免疫反应（2例）。4例中央移植物透明的患者在随访20至30个月期间不再接受全身CSA治疗。
中央角膜缘移植术是一种非常有前景的手术。然而，目前的平均效果并不令人满意，因为大多数角膜缘干细胞在2年内会发生排斥反应。未来，通过使用匹配良好而非不匹配的移植物，并在现有CSA治疗效果的基础上进一步改善免疫调节，有望取得更好的结果。
