Abstract：
OBJECTIVE: The purpose of this study was to introduce a new method of limbal stem cell transplantation using autologous platelet-rich plasma (E-PRP) eye drops for unilateral total limbal stem cell deficiency.
METHODS: Patients with total unilateral limbal stem cell deficiency due to chemical burn underwent mini-conjunctival limbal autograft using autologous E-PRP drops. One small limbal block, measuring 2 × 2 mm, was harvested from the patients\' contralateral healthy eye and transplanted to the diseased eye. All patients received E-PRP drops until achieving complete corneal epithelialization. Subsequent corneal transplantation was performed in eyes with significant stromal opacification. Corneal buttons obtained during corneal transplantation underwent immunohistochemistry for the evaluation of limbal stem cell markers (ABCG2 and P63). Visual acuity, epithelial healing, corneal clarity, and regression of corneal conjunctivalization/vascularization were evaluated after surgery.
RESULTS: Ten patients with acid (n = 7) or alkali (n = 3) burn were included. The mean follow-up period was 21.7 ± 5.8 months (range, 12-32 months). Corneas were completely reepithelialized within 14.9 ± 3.5 days (range, 11-21 days). Corneal conjunctivalization/vascularization dramatically regressed 1 to 2 months after surgery in all cases, and corneal clarity considerably improved in 7 patients. In the 3 eyes with significant stromal opacification, subsequent optical penetrating keratoplasty was performed. The ocular surface was stable throughout the follow-up period in all eyes. BSCVA improved to 0.60 ± 0.0.32 and 0.46 ± 0.0.25 logMAR in eyes with and without corneal transplantation, respectively, at the final follow-up visit. ABCG2 and P63 markers were detected on corneal buttons after keratoplasty.
CONCLUSIONS: Based on our clinical and laboratory findings, mini-conjunctival limbal autograft using E-PRP can be considered as a promising alternative to ocular surface reconstruction.
METHODS: Patients with total unilateral limbal stem cell deficiency due to chemical burn underwent mini-conjunctival limbal autograft using autologous E-PRP drops. One small limbal block, measuring 2 × 2 mm, was harvested from the patients\' contralateral healthy eye and transplanted to the diseased eye. All patients received E-PRP drops until achieving complete corneal epithelialization. Subsequent corneal transplantation was performed in eyes with significant stromal opacification. Corneal buttons obtained during corneal transplantation underwent immunohistochemistry for the evaluation of limbal stem cell markers (ABCG2 and P63). Visual acuity, epithelial healing, corneal clarity, and regression of corneal conjunctivalization/vascularization were evaluated after surgery.
RESULTS: Ten patients with acid (n = 7) or alkali (n = 3) burn were included. The mean follow-up period was 21.7 ± 5.8 months (range, 12-32 months). Corneas were completely reepithelialized within 14.9 ± 3.5 days (range, 11-21 days). Corneal conjunctivalization/vascularization dramatically regressed 1 to 2 months after surgery in all cases, and corneal clarity considerably improved in 7 patients. In the 3 eyes with significant stromal opacification, subsequent optical penetrating keratoplasty was performed. The ocular surface was stable throughout the follow-up period in all eyes. BSCVA improved to 0.60 ± 0.0.32 and 0.46 ± 0.0.25 logMAR in eyes with and without corneal transplantation, respectively, at the final follow-up visit. ABCG2 and P63 markers were detected on corneal buttons after keratoplasty.
CONCLUSIONS: Based on our clinical and laboratory findings, mini-conjunctival limbal autograft using E-PRP can be considered as a promising alternative to ocular surface reconstruction.
摘要：
目的：本研究的目的是介绍一种使用自体富血小板血浆（E-PRP）滴眼液治疗单侧角膜缘干细胞缺乏症的角膜缘干细胞移植新方法。
方法：化学烧伤导致单侧角膜缘干细胞完全缺乏的患者使用自体E-PRP滴剂进行小型结膜自体角膜缘移植术。一个小角膜缘区块，测量2×2毫米，从患者对侧健康眼睛收获并移植到患病眼睛。所有患者均接受E-PRP滴剂直至实现完全角膜上皮化。随后在具有明显基质混浊的眼睛中进行了角膜移植。角膜移植期间获得的角膜纽扣进行了免疫组织化学，以评估角膜缘干细胞标志物（ABCG2和P63）。视敏度,上皮愈合，角膜透明度,术后评估角膜结扎/血管化的消退。
结果：包括10例酸（n=7）或碱（n=3）烧伤患者。平均随访时间为21.7±5.8个月(范围，12-32个月）。角膜在14.9±3.5天内完全上皮化（范围，11-21天）。在所有病例中，手术后1至2个月角膜结合法/血管化显著消退，7例患者角膜透明度明显改善。在3只具有显著基质混浊的眼睛中，随后进行光学穿透性角膜移植术.在整个随访期间，所有眼睛的眼表都是稳定的。在有和没有角膜移植的眼中，BSCVA提高到0.60±0.0.32和0.46±0.0.25logMAR，分别,在最后的后续访问中。角膜移植术后在角膜纽扣上检测到ABCG2和P63标记。
结论：根据我们的临床和实验室检查结果，使用E-PRP的小型结膜角膜缘自体移植可以被认为是眼表重建的有希望的替代方法。
方法：化学烧伤导致单侧角膜缘干细胞完全缺乏的患者使用自体E-PRP滴剂进行小型结膜自体角膜缘移植术。一个小角膜缘区块，测量2×2毫米，从患者对侧健康眼睛收获并移植到患病眼睛。所有患者均接受E-PRP滴剂直至实现完全角膜上皮化。随后在具有明显基质混浊的眼睛中进行了角膜移植。角膜移植期间获得的角膜纽扣进行了免疫组织化学，以评估角膜缘干细胞标志物（ABCG2和P63）。视敏度,上皮愈合，角膜透明度,术后评估角膜结扎/血管化的消退。
结果：包括10例酸（n=7）或碱（n=3）烧伤患者。平均随访时间为21.7±5.8个月(范围，12-32个月）。角膜在14.9±3.5天内完全上皮化（范围，11-21天）。在所有病例中，手术后1至2个月角膜结合法/血管化显著消退，7例患者角膜透明度明显改善。在3只具有显著基质混浊的眼睛中，随后进行光学穿透性角膜移植术.在整个随访期间，所有眼睛的眼表都是稳定的。在有和没有角膜移植的眼中，BSCVA提高到0.60±0.0.32和0.46±0.0.25logMAR，分别,在最后的后续访问中。角膜移植术后在角膜纽扣上检测到ABCG2和P63标记。
结论：根据我们的临床和实验室检查结果，使用E-PRP的小型结膜角膜缘自体移植可以被认为是眼表重建的有希望的替代方法。
