组织工程角膜上皮移植重建眼表面的临床研究

目的 观察组织工程角膜上皮移植重建眼表面治疗完全性角膜上皮干细胞缺乏的短期临床效果.方法 系列病例研究.6例(6眼)单眼全角膜缘干细胞缺乏患者,包括碱烧伤3例、爆炸伤2例、热烧伤1例.采用去上皮羊膜组织作为载体,体外扩增患者自体健眼角膜上皮干细胞,构建组织工程角膜上皮.然后进行组织工程角膜上皮移植重建眼表面.术前及术后检查指标包括裸眼视力、裂隙灯显微镜、超声生物显微镜、泪液分泌试验.结果 患者自体来源的角膜上皮干细胞在去上皮羊膜上培养3周后均可形成直径15 mm的复层上皮片.组织工程角膜上皮均成功移植于所有受体眼表面.移植术后3个月,所有患者角膜上皮完整光滑,角膜瘢痕及纤维血管翳明显减轻,6例患者视力均有不同程度的提高.结论 患者自体来源的角膜上皮干细胞构建的组织工程角膜上皮移植可以成功重建全角膜缘干细胞缺乏患者的眼表面,为这类患者的复明带来希望.

Ocular surface reconstruction with tissue-engineered corneal epithelium

Objective To investigate the short-term outcome of ocular surface reconstruction with tissue-engineered corneal epithelium in the treatment of total limbal stem cell deficiency (LSCD).Methods In a case series,6 eyes of 6 patients with total LSCD resulting from severe chemical injury (3 eyes),blast injury (2 eyes),or thermal burn (1 eye) were included in this study.Denuded amniotic membrane was used as the carrier to culture autologous corneal epithelial stem cells to construct tissue-engineered corneal epithelium.After that,tissue-engineered corneal epithelium was transplanted onto the LSCD ocular surface after removal of the corneal pannus.Visual acuity,slit lamp photography,ultrasound biomicroscopy (UBM) and Schirmer I test were performed before surgery and during the follow-up.Results After cell culture for 3 weeks,the autologous corneal epithelial cells proliferated and formed a stratified epithelial cell sheet 15 mm in diameter.All tissue-engineered corneal epithelia were successfully transplanted onto the ocular surface of the LSCD patients.Three months after surgery,there were no epithelial defects in the recipient corneas and the corneal surface remained smooth.Corneal scar tissue was removed and the pannus was significantly reduced.There was an improvement in visual acuity in all patients.Conclusion Transplantation of tissue-engineered corneal epithelia based on the ex-vivo expansion of autologous corneal epithelial stem cells may be an effective treatment to reconstruct the ocular surface of LSCD patients.