目的:回顾已发表的关于角膜缘异体移植(KLAL)和活体结膜缘异体移植(lr-CLAL)治疗双侧严重/完全角膜缘干细胞缺乏症(LSCD)的安全性和结局的文献。
方法:文献检索最后一次在2023年2月在PubMed数据库中进行,仅限于英语。他们引用了523篇;全文回顾了76篇,21人符合纳入标准。两项研究被评为二级,其余19项研究被评为III级.没有一级研究。
结果:KLAL手术后,最佳矫正视力(BCVA)在最终随访时改善了42%至92%的眼睛(范围,12-95个月)。BCVA在17%至39%的眼睛中没有变化,在8%至29%的眼睛中下降。评估KLAL结果的14项研究中有两项报告术后视力随时间显着下降。KLAL的存活率是可变的,在最后一次随访时从21%到90%(范围,12-95个月),并随着时间的推移而下降。对于接受lr-CLAL手术的患者,最终随访时,BCVA改善了31%至100%的眼睛(范围,16-49个月)。在评估lr-CLAL的9项研究中,4报告BCVA在30%至39%的患者中没有变化,和3报告8%至10%的患者BCVA下降。最终随访时lr-CLAL的生存率范围为50%至100%(范围,16-49个月)。最常见的并发症是术后眼压升高,持续性上皮缺损,和急性同种异体移植免疫排斥反应。
结论:考虑到双侧LSCD患者的选择有限,KLAL和lr-CLAL都是可行的选择,可以改善视力和眼表表现.lr-CLAL的研究倾向于较低的排斥率和移植物失败。然而,免疫抑制的水平和持续时间在研究之间差异很大,可能会影响同种异体移植物排斥和长期存活。与免疫抑制相关的并发症很少。可能需要重复手术以维持可行的眼表。KLAL和lr-CLAL在适当的全身性免疫抑制下都可以获得合理的长期成功。
背景:专利或商业公开可以在参考文献之后找到。
OBJECTIVE: To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency (LSCD).
METHODS: Literature searches were last conducted in the PubMed database in February 2023 and were limited to the English language. They yielded 523 citations; 76 were reviewed in full text, and 21 met the inclusion criteria. Two studies were rated level II, and the remaining 19 studies were rated level III. There were no level I studies.
RESULTS: After KLAL surgery, best-corrected visual acuity (BCVA) improved in 42% to 92% of eyes at final follow-up (range, 12-95 months). The BCVA was unchanged in 17% to 39% of eyes and decreased in 8% to 29% of eyes. Two of 14 studies that evaluated the results of KLAL reported a notable decline in visual acuity over time postoperatively. Survival of KLAL was variable, ranging from 21% to 90% at last follow-up (range, 12-95 months) and decreased over time. For patients undergoing lr-CLAL surgery, BCVA improved in 31% to 100% of eyes at final follow-up (range, 16-49 months). Of the 9 studies evaluating lr-CLAL, 4 reported BCVA unchanged in 30% to 39% of patients, and 3 reported a decline in BCVA in 8% to 10% of patients. The survival rate of lr-CLAL ranged from 50% to 100% at final follow-up (range, 16-49 months). The most common complications were postoperative elevation of intraocular pressure, persistent epithelial defects, and acute allograft immune rejections.
CONCLUSIONS: Given limited options for patients with bilateral LSCD, both KLAL and lr-CLAL are viable choices that may provide improvement of vision and ocular surface findings. The studies trend toward a lower rejection rate and graft failure with lr-CLAL. However, the level and duration of immunosuppression vary widely between the studies and may impact allograft rejections and long-term graft survival. Complications related to immunosuppression are minimal. Repeat surgery may be needed to maintain a viable ocular surface. Reasonable long-term success can be achieved with both KLAL and lr-CLAL with appropriate systemic immunosuppression.
BACKGROUND: Proprietary or commercial disclosure may be found after the references.