摘要
目的观察自体角膜缘干细胞移植联合羊膜移植术治疗角膜缘干细胞失代偿的有效性与安全性。方法采用回顾性研究方法,统计分析2014年6月~2016年6月在武汉同济医院眼科住院的角膜缘干细胞失代偿患者资料,所有患者均采用自体角膜缘干细胞移植联合羊膜移植术治疗。采用裂隙灯显微镜照相、眼前节光学相干断层扫描(OCT)等方法检查,并记录手术患者手术前后视力、新生血管面积及其并发症,随访观察5~38个月。结果共计9例患者纳入该研究,其中7例患者完成5个月以上随访。术前视力为光感~0.25,平均(0.025±0.017),术后最佳矫正视力为0.05~0.3,平均(0.097±0.094),术后视力较术前视力平均增加(0.076±0.080)(P=0.037)。术前角膜新生血管面积平均为(75.968±25.973)mm2,术后为(36.472±31.810)mm2,较术前明显减少(P=0.008)。OCT检查显示术前中央角膜厚度410~577μm,平均(495.778±56.464)μm,角膜前血管膜厚度150~956μm,平均(325.111±235.127)μm,术后角膜厚度420~570μm,平均(492.857±47.121)μm,与术前比较厚度无明显差异(P=0.630)。角膜前膜行病理切片苏木精-伊红染色,可见病变组织表面被覆复层扁平上皮,上皮下为致密纤维组织及血管增生。随访过程中2例患者手术出院后即失访,2例患者术后3个月时复发,复发率28.57%。所有患者没有感染发生,但是1例患者出现上皮愈合延迟。结论自体角膜缘干细胞移植联合羊膜移植术是治疗角膜缘干细胞失代偿的有效方法。
Objective To observe the efficacy and safety of autologous limbal stem cell combined with amniotic membrane transplantation for treatment of limbal stem cell deficiency.Methods By using retrospective research method,patients with limbal stem cell deficiency from June 2014 to June 2016 in the Department of Ophthalmology of Tongji Hospital were statistically analyzed.All of the patients were treated with autologous limbal stem cells combined with amniotic membrane transplantation.The ocular surface of the patients was examined with slit lamp microscope and anterior segment optical coherence tomography（OCT）.Patient＇s best corrected vision acuity（BCVA）,area of new blood vessels and complications were recorded as the major outcome indicators during a follow-up time of 5 to 38 months.Results A total of nine patients were included in this study,among which 7 patients completed a follow-up of more than 5 months.The preoperative BCVA ranged from light perception to 0.25,averaged（0.025±0.017）.The postoperative BCVA ranged from 0.05 to 0.3,averaged（0.097±0.094）,with an increase of（0.076±0.080）（P=0.037）.Preoperative corneal neovascularization area[（75.968±25.973）mm2]was significantly higher than the postoperative corneal neovascularization area[（36.472±31.810）mm2]（P=0.008）.OCT examination showed that the preoperative central corneal thickness ranged from 410 to 577μm,averaged（495.778±56.464）μm.The thickness of vascular membrane at the surface of cornea ranged from 150 to 956μm,averaged（325.111±235.127）μm.The postoperative central cornea thickness ranged from 420 to 570μm,averaged（492.857±47.121）μm,changed without statistically difference as compared to preoperative data（P=0.630）.HE staining showed that the membrane at the surface of cornea was made of stratified squamous epithelium,dense fibrous tissue and blood vessels.Two out of the nine patients were dropped out from the followup list within 3 months for their own reasons,the other 7 finished a follow-up time longer than 3 months.Two cases of patients at postoperative 3 months with the vascular membrane tissue ingrowth into the corneas were observed in two patients,who werejudged as recurrence（28.57%）,no infection was reported,but one patient experienced delayed epithelial recovery during the following up time.Conclusion The outcome of this study suggests that autologous limbal stem cells combined with amniotic membrane transplantation could be an effective method for treatment of limbal stem deficiency.
作者
王孟妮
王平
徐玲娟
王玮
蔡苏博
李莘
朱晖
李贵刚
Wang Mengni;Wang Ping;Xu Lingjuan(Department of Ophthalmology,Affiliated Renhe Hospital of China Three Gorges University,Yichang 443000,China;Department of Ophthalmology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2018年第3期344-348,共5页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
关键词
自体角膜缘干细胞移植
羊膜移植
角膜缘干细胞失代偿
autologouslimbalstem cell transplantation
ammniotic membrane transplantation
limbal stem cell deficiency
