亲属供体角膜缘移植治疗化学烧伤致角膜缘衰竭的初步疗效

目的 探讨亲属供体角膜缘干细胞移植治疗化学伤引起的角膜缘干细胞衰竭的疗效和并发症.方法 回顾性对照病例研究.2006年4月至2007年12月中山大学中山眼科中心对12例(12只眼)化学伤引起的角膜缘干细胞衰竭连续病例,使用人类白细胞抗原(HLA)匹配(10例)或不匹配(2例)的亲属供体行角膜缘移植,并与同期施行异体角膜缘移植的15例化学伤性角膜缘衰竭患者比较.行亲属供体角膜缘移植的后8例患者和全部异体角膜缘移植的患者术后均全身使用环胞素A.术后观察上皮愈合、新生血管、角膜透明度及视力等.随访12～27个月.两组间术后角膜上皮化时间的差异采用t检验,两组间眼表重建成功率、新生血管复发率及植片排斥率的差异采用卡方检验.结果 亲属供体角膜缘移植组有10只眼(83.3%)于术后(9.6±3.4)d角膜上皮愈合,9只眼(75.0%)术后恢复了稳定的眼表;术后5～8个月,成功重建眼表的9只眼中有7只眼(77.8%)出现角膜周边部新生血管复发.而异体角膜缘移植组有12只眼(80.0%)于术后(11.2±4.6)d角膜上皮愈合,7只眼(46.7%)术后恢复了稳定的眼表;术后4～10个月,成功重建眼表的7只眼全部出现角膜周边部新生血管复发.两组术后上皮愈合率和愈合时间比较,差异均无统计学意义(χ2=1.764,P=0.117;t=0.116,P=0.133);但眼表重建成功率和术后远期新生血管复发率比较,差异均有统计学意义(χ2=4.158,P=0.015;χ2=3.463,P=0.022).在成功重建眼表的患者中,亲属供体角膜缘移植组术后有2例出现植片排斥,其中1例发生在HLA匹配的受体,另1例发生在HLA不匹配的受体;而异体角膜缘移植组有3例出现植片排斥.所有供体眼术后均未出现并发症.结论 亲属供体角膜缘移植可有效地重建眼化学伤患者的眼表.使用HLA匹配的供体,并全身使用环胞素A,能有效减少术后植片排斥,延长植片的存活.

Limbal allografting from related live donors for limbal stem cell deficiency secondary to ocular chemical burn

Objective To investigate the efficacy and complications of limbal allografting from related live donors (RL-LAT) for limbal stem cell deficiency secondary to ocular chemical burn. Methods Retrospective comparative case series. Limbal allografting from related live human leukocyte antigen ( HLA)-matched ( n = 10) and-unmatched donors ( n = 2) was performed in 12 consecutive patients (12 eyes) with limbal stem cell deficiency secondary to ocular chemical burn, including 9 alkali burn and 3 acid burn; whereas allolimbal cadaver transplant was performed in another 15 patients in Zhongshan Ophthalmic Center between April 2006 to December 2007. Systemic cyclosporine A was administered to later eight recipients in living related donor group and all patients in cadaver donor group. Main outcome measures were restoration of corneal epithelium, reduction in corneal vascularization, improved corneal clarity, and visual improvement. Mean follow-up was (11.4 ±3.6) months (from 12 to 27). Results In living related donor group, ten patients (83.3%) achieved initially reepithelialize, and epithelial healing time was (9. 6 ± 3.4 ) d. Nine patients ( 75.0% ) achieved stable ocular surface ( stable corneal epithelium,decreased vascularization of corneal surface, and reduced corneal opacification). However, in seven eyes (77. 8% ) achieved stable ocular surface, gradual recurrence of peripheral corneal vascularization occurred after 5 to 8 months postoperatively. Whereas in cadaver donor group, twelve patients ( 80. 0% ) achieved initially reepithelialize, and epithelial healing time was ( 11.2 ±4. 6) d. Seven patients (46. 7% ) achieved stable ocular surface. However, in all seven eyes achieved stable ocular surface, gradual recurrence of peripheral corneal vascularization occurred after 4 to 10 months postoperatively. The differences of both the rate of initially reepithelialize and epithelial healing time between these two groups showed no statistical significance( χ2 = 1.764, P = 0.117; t = 0.116, P = 0.133, respectively). However, the differences of both the successful rate of ocular surface reconstruction and the recurrent rate of corneal vascularization during the follow-up period between these two groups were statistically significant(χ2=4.158, P =0.015;χ2 = 3. 463, P = 0. 022, respectively). In living related donor group, features of graft rejection developed in two patients with postoperative stable ocular surface, Both rejected recipients had one among HLA-matched and one among-unmatched respectively. Whereas in cadaver donor group, features of graft rejection developed in three patients with postoperative stable ocular surface. None of the donor eyes had any complications. Conclusions Limbal allografting from related live donors is more effective to reconstruct the ocular surface of limbal stem cell deficiency secondary to ocular chemical burn than allolimbal cadaver transplant. HLA-matched limbal allografting could reduce postoperative graft rejection and systemic cyclosporine A is useful in ensuring long-term survival.