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眼表面干细胞同种异体移植的长期预后

Movahedan, A., Cheung, A.Y., Eslani, M., Mogilishetty, G., Govil, A., Holland, E.J.

期刊名称:American journal of ophthalmology

卷期:2017年第184卷

摘要

摘要:目的:旨在探讨表面干细胞移植(OSST)对多种病因引起的全因性角膜缘干细胞缺乏症(LSCD)患者的远期疗效,随访5年以上。设计:回顾性介入性队列研究。方法:设置:单个三级转诊医院。研究人群:患者符合(1LSCD患者,(2)至少1次同种异体移植OSST手术治疗,以及(3OSST后最小随访≥5年。干预:所有患者均于19983月至20096月接受同种异体移植OSST治疗。所有患者均接受全身免疫抑制治疗。结果:110例患者的165只眼符合纳入标准,平均随访时间为109.22±35.7个月或约9.1年(5.2-17.7年)。 末次随访时,72.7%眼的(120/165)眼表面稳定,15.2%(25/165)眼表面改善,12.1%(20/165)表面失败。 30.9%的眼(51/165)需要额外的osst手术来维持稳定的眼表。 结论:在适当的免疫抑制和重复手术治疗失败的情况下,同种异体OSST可提供真实的长期眼表稳定性和成功的视觉预后。

PURPOSE:To investigate the long-term outcomes of ocular surface stem cell allograft transplantation (OSST) in patients with total limbal stem cell deficiency (LSCD) owing to various etiologies with a follow-up 5 years.DESIGN:Retrospective interventional cohort.METHODS:Setting: Single tertiary referral hospital.STUDY POPULATION:Patients who had (1) presence of total LSCD, (2) surgical treatment with at least 1 allograft OSST procedure, and (3) minimum follow-up 5 years after OSST.INTERVENTION:All patients underwent allograft OSST from March 1998 to June 2009. All patients received systemic immunosuppression.MAIN OUTCOME MEASURES:Ocular surface stability, best-corrected visual acuity (BCVA).RESULTS:A total of 165 eyes of 110 patients fulfilled the inclusion criteria with a mean follow-up period of 109.22 ± 35.7months or approximately 9.1 years (range 5.2-17.7 years). Ocular surface stability was achieved in 72.7% (120/165) of eyes at last follow-up, while 15.2% (25/165) maintained an improved ocular surface and 12.1% (20/165) developed total surface failure. Additional OSST surgery was necessary in 30.9% (51/165 eyes) to maintain a stable ocular surface. There was 2 lines BCVA improvement in 62.1%, no change in 7.7%, and a worsened BCVA in 18.6% at last follow-up.CONCLUSIONS:With proper immunosuppression and repeat procedure in case of failure, allograft OSST can provide true long-term ocular surface stability and successful visual outcomes.


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