带角膜缘干细胞的板层角膜移植术治疗严重角膜病变

Lamellar Keratoplasty with Limbal Stem Cells for Treating Serious Corneal Diseases

目的报告带角膜缘干细胞的异体板层角膜移植术治疗严重角膜病变的疗效.方法供体角膜选用新鲜尸体眼球,制作的板层角膜植片包括透明角膜、角膜缘和角膜缘周围4 mm的巩膜,移植到已去除病变组织的眼球表面,观察眼表结构的愈合情况.结果 63例(63眼)角膜病变患者被实施了带角膜缘干细胞的板层角膜移植术,经过5～52月,平均(12.5±6.2)月的随访,大部分患者维持较稳定的眼表,但有3例患者出现明显的上皮排斥反应,经过强化抗排斥治疗,2例被控制;1例蚕蚀性角膜溃疡患者于术后6月复发;所有角膜良性肿瘤患者在随访期内均未见复发.结论带有活性角膜缘干细胞的异体板层角膜移植是治疗伴有角膜缘干细胞缺乏或功能障碍的严重角膜病变的较好方法.

Objective To investigate effects of allotransplantation of lamellar cornea with limbal stem cells for treating serious ocular surface disorders. Methods The fresh donor＇s corneas were selected, lamellar cornea implants comprised transparent cornea, limbus cornea and 4mm sclera around limbus. It was transplanted on the surface of eyeball for treating ocular surface disorders. The ocular surface was assayed regularly by slit-lamp microscope. Results There were 63 patients （63 eyes） were performed allograft transplantation of lamellar cornea with limbal stem cells. During 5 to 52 months[mean（12.5±6.2）months] follow up, most patients＇ ocular surfaces maintained smoothly. But, 3 cases （3 eyes） with cicatricial alkali burns occurred visible epithelial rejection, and 2 cases were controlled after adding dosage of glucocorticosteroid and Cyclosporin A. 1 cases with Mooren＇s ulcer recurred in 6 months after surgery. All patients with corneal benign tumor did not recur during follow-up. Conclusion Allotransplantation of lamellar cornea with viable limbal stem cells can be used to treat serious ocular surface disorders with limbal stem cells defect or functional disturbance.