Baradaran-Rafii, A., Delfazayebaher, S., Aghdami, N., Taghiabadi, E., Bamdad, S., Roshandel, D.
期刊名称：The Ocular Surface
移植术 上皮 角膜
摘要：目的：旨在评估化学灼伤患者双侧总角膜缘干细胞缺乏（LSCD）患者培养口腔粘膜上皮移植（COMET）后穿透性角膜移植术（PKP）的中期预后。方法：在这项前瞻性介入性非随机病例系列中，成功COMET后，对患有严重基质不透明的患者进行光学PKP。主要预后指标为眼表面稳定性，视力改善和角膜移植存活率。结果：共包括14例成功COMET的14只眼。 PKP和COMET之间的时间间隔为7.6±1.3个月（6-9个月）。平均随访期为28.2±8个月（14-40个月，中位数30个月）。所有眼在7天后上皮愈合。在最终检查中，13只眼具有稳定的眼表，无上皮缺损。角膜表面被覆透明上皮，没有明显的新生血管形成。 PKP后3个月，1只眼持续发生上皮缺损，认为是移植失败。最佳矫正视力从术前的2.67±0.08 LogMAR增加到PKP后的0.64±0.27 LogMAR（P <0.001）。4例患者发生内皮抑制，经全身和局部皮质类固醇成功治疗。总体和无排斥移植物存活率分别为92.9%和69.2％。结论：COMET后PKP是一种成功的手术，可用于恢复由于化学灼伤引起的严重基质不透明伴双侧总LSCD的视力功能。
PURPOSE:To evaluate the midterm outcomes of penetrating keratoplasty (PKP) after cultivated oral mucosal epithelial transplantation (COMET) in patients with bilateral total limbal stem cell deficiency (LSCD) due to chemical burn.METHODS:In this prospective interventional nonrandomized case series, optical PKP was performed in patients with severe stromal opacity after successful COMET. Main outcome measures were stability of the ocular surface, visual acuity improvement and corneal graft survival.RESULTS:Fourteen eyes of 14 patients with successful COMET were included. Time interval between PKP and COMET was 7.6 ± 1.3 months (6-9 months). Mean follow-up period was 28.2 ± 8 months (14-40 months, median 30 months). Epithelial healing was complete after 7 days in all eyes. Thirteen eyes had stable ocular surface without epithelial defect at final examination. The corneal surface had been covered by a transparent epithelium without significant neovascularization. Persistent epithelial defect developed in one eye 3 months after PKP which was considered as graft failure. Best-corrected visual acuity increased from 2.67 ± 0.08 LogMAR preoperatively to 0.64 ± 0.27 LogMAR after PKP (P < 0.001). Endothelial rejection occurred in four patients and was successfully managed by systemic and topical corticosteroids. Overall and rejection-free graft survival rates were 92.9 and 69.2%, respectively.CONCLUSION:PKP after COMET is a successful procedure which can be used to restore visual function in cases with bilateral total LSCD associated with severe stromal opacity due to chemical burns.