组织工程口腔黏膜移植治疗重症眼表烧伤

Tissue-engineered oral mucosal epithelial cells to reconstruct ocular surface in patients with severe corneal burn

目的观察组织工程培养自体口腔黏膜代替角膜上皮细胞治疗重症眼表烧伤的临床效果。方法本院收治的化学伤和热烧伤患者7例(8只眼),取自体口腔下唇黏膜约10 mm×5 mm培养21~38 d,培养方法:新鲜标本用氯霉素冲洗3遍,PBS充分洗3遍后,将标本放入dispase中消化,4℃过夜,第2天将口腔黏膜上皮与皮下组织分开,将上皮组织剪碎后放入酶中37℃消化10~20 min后离心1000转5 min,弃上清,培养液重悬细胞后接种。手术方法:冻干羊膜为载体,口腔黏膜上皮细胞面向下,羊膜面向上平铺于眼球上并填塞于结膜下,术后每日点滴0.1%妥布霉素地塞米松眼膏,绷带加压包扎,共2周。2周后术眼点滴人工泪液治疗,未使用抗生素、抗排斥等药物。结果 8只眼术后角膜炎症浸润反应减轻,角膜光滑,荧光素染色无着色。但随访显示所有角膜最终仍发生不同程度的血管化。1例患者半年后行角膜移植术,切除角膜组织病理检查报告:纤维组织内多量淋巴细胞,少量嗜酸性粒细胞浸润,部分区可见成排毛细血管,部分区可见条状红染匀质物,部分区域有少量复层鳞状上皮覆盖。结论组织工程自体口腔黏膜移植在治疗重症眼表烧伤和眼表重建中有一定的效果,但长期效果仍需进一步研究和探索,改进培养技术,才能达到更好的临床治疗效果。

Objective Severe ocular surface diseases often lead to disruption of the corneal surface by invading neighboring conjunctival epithelial cells. Since there are no healthy conjunctival epithelia,cornea epithelia and limbal epithelia available for auto transplantation,ocular surface reconstruction is difficult. This study tried to evaluate clinical efficacy of using tissue-engineered oral mucosal epithelial cells for ocular surface reconstruction. Methods Eight eyes of seven patients with severe ocular surface damage due to thermal or chemical burns were treated with tissue-engineered oral mucosal epithelial cells. Corneal leukoma,fibrous tissues and neovascularization tissues were excised completely. Tissue-engineered oral mucosal epithelial cells on the amnions were transplanted to each eye. Visual acuity,corneal surface erosions and symptoms were observed to evaluate the effect. Results Corneas in all 8 eyes were epithelized and became more pellucid after surgery. The structure of ocular surface in all corneas was recovered to various degrees. Scars and fibroplastic proliferation of corneas decreased and symblepharon was relieved. Postoperative BCVA of one eye was 20/100 and others were finger count. Conclusions Ocular surface reconstruction of severe ocular injury is a difficult task. Using the cultivated mucosal epithelial transplantation improves visual outcome and structural and functional recovery of ocular surface.