角膜上皮移植术治疗角膜缘干细胞功能障碍临床探究

Clinical study on keratolimbal allograft for treating limbal stem cell deficiency

目的探讨多种角膜上皮移植术式治疗角膜缘干细胞功能衰竭的手术技术和成败因素.方法根据角膜缘受损程度,用全角膜上皮移植、指环形上皮移植、次全角膜上皮移植和蕈状瓣移植4种不同术式治疗38例(42眼)角膜缘干细胞功能衰竭;术后环孢素和/或糖皮质激素口服2～9个月,联合局部滴眼至少12个月防范移植排斥;总结临床规律和成败因素. 结果术后平均随访14.5个月(3～25个月),35眼(83.3%)视力≥0.05,其中31眼裸眼视力≥0.3;失败5例中,4例为Ⅳ度眼表烧伤,并发眼睑缺损和睑球粘连;另一例因术中植床穿破,术后长期双前房导致植片水肿混浊. 结论同种异体角膜上皮移植术通过角膜缘干细胞移植,使患眼回归正常的生理状态而恢复视力或重新获得稳定的眼表;为尔后的增视性角膜和/或晶状体手术提供了稳定的解剖学基础.

Objective To investigate the surgical technique of keratolimbal allograft（KLAL） and the factors of affecting surgery succession. Methods Four kinds of KLAL methods including pan graft, annular graft, subtotal graft and mushroom graft were performed on 42 eyes of 38 patients with limbal stem cell deficiency. Systemic immunosuppression agents were used for 2 to 9 months and topical eyelosporine and steroid eyedrops for more than 12 months after surgery. The clinical regularity and affecting factors of surgery were investigated. Results A follow-up of 14.5 months （ranged from 3 to 25 months） revealed that 35 eyes （83.3 % ）got clear cornea and visual acuity was 0. 05 ,and 31 eyes of them was ≥0. 3. Five eyes underwent a failed surgery procedure,and 4 of them suffered from IV degree of chemical burns and severe lid defect and symblepharon. The another one resulted in bullous keratopathy from Deseemet membrane perforation during the operation, inducing a appearance of double anterior chambers. Epithelial rejection occurred in 6 eyes 1 to 6 months after surgery. Conclusion Keratolimbal allograft is an effective method to supply with epithelial cell regeneration resource for patient with limbal stem cell deficiency. Most of patients in present group get useful vision and maintained a stable ocular surface after surgery.