Purpose

This study was conducted to determine the long-term outcomes of cultivated cell sheet transplantation (CCST), and to clarify risk factors that affected the outcomes.

Methods

We retrospectively analyzed the medical charts and photographs of 246 consecutive surgeries (162 eyes from 139 patients) that used CCST for treating total limbal stem cell deficiency. Deficiency types included Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis (SJS/TEN; n = 80), ocular surface burns (Burn; n = 75), ocular cicatricial pemphigoid (OCP) or pseudo-OCP (n = 58), and others (n = 33). The methods of CCST included 103 cultivated limbal epithelial transplantations (28 autologous, 62 allogeneic, and 13 living-related relatives), and 143 cultivated oral mucosal epithelial transplantations. We analyzed the rate of successful ocular surface reconstruction, clear corneas, and best-corrected visual acuity equal to or better than 20/200.

Results

With a mean observation period of 357 weeks, successful ocular surface reconstruction and clear corneas at last visit were achieved in 65.1% of the patients. Corrected visual acuity equal to or better than 20/200 was achieved in 19.0% of the patients. Eyes with SJS/TEN exhibited worse outcomes compared with the Burn group. Postoperative complications included corneal ulcerations or perforations (18.3%), glaucoma (13.8%), and infections (8.5%). Multivariate analyses using the logistic mixed-effects model indicated that the presence of preoperative corneal epithelial defects was a significant risk factor for postoperative failure.

Conclusions

In this series, the success rate of CCST after a mean observation period of 357 weeks was 65.1%, and preoperative epithelial defect was the most relevant risk factor.

中文翻译：

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培养细胞片移植治疗总角膜缘干细胞缺乏症的长期结果。

目的

进行这项研究是为了确定培养细胞片移植（CCST）的长期结果，并阐明影响结果的危险因素。

方法

我们回顾性分析了使用CCST治疗全部角膜缘干细胞缺乏症的246例连续手术（来自139例患者的162眼）的医学图表和照片。缺乏类型包括史蒂文斯-约翰逊综合征（SJS）或中毒性表皮坏死溶解（SJS / TEN; n = 80），眼表烧伤（Burn; n = 75），眼瘢痕类天疱疮（OCP）或假OCP（n = 58） ，以及其他（n = 33）。CCST的方法包括103例种植的角膜缘上皮移植（28例自体，62例同种异体的和13例与生命有关的亲戚）和143例种植的口腔粘膜上皮移植。我们分析了成功的眼表重建，透明角膜和最佳矫正视力等于或大于20/200的比率。

结果

平均观察期为357周，在65.1％的患者中，在最后一次就诊时成功完成了眼表重建和透明角膜。在19.0％的患者中，矫正的视力达到或等于20/200。与烧伤组相比，具有SJS / TEN的眼睛表现出较差的结果。术后并发症包括角膜溃疡或穿孔（18.3％），青光眼（13.8％）和感染（8.5％）。使用logistic混合效应模型进行的多变量分析表明，术前角膜上皮缺损的存在是术后失败的重要危险因素。

结论

在该系列中，平均观察期357周后CCST的成功率为65.1％，而术前上皮缺损是最相关的危险因素。