Abstract

This study compared the clinical outcomes of amniotic membrane transplantation with and without cultured limbal epithelium for persistent corneal ulcers. The study included 30 patients that were assigned to either human amniotic membrane transplantation (AMT) only or a two-step cultured limbal epithelial transplant (CLET) with amniotic membrane carrier. The patients underwent a comprehensive ocular examination, Cochet-Bonnet esthesiometry, impression cytology and anterior segment optical coherence tomography (AS-OCT). Slit-lamp images before and after treatment were analyzed using ImageJ to compare the fibrovascular tissue area. The state of epithelialization was assessed by fluorescein staining on day 30. Mean age of patients was 64 ± 20.39 in the AMT group and 55.17 ± 14.51 in the CLET group (p = 0.16). Visual acuity improved significantly in both groups after treatment, but the improvement was significantly greater in the CLET group (p = 0.022). Impression cytology demonstrated PAS + cells in the corneal epithelium in 9 patients from the CLET group and 10 patients in the AMT group (p = 0.704). Cochet-Bonnet esthesiometry increased significantly after treatment with a similar rate between groups (p = 0.435). Improvement with reduction of the fibrovascular tissue area was achieved in both groups (p < 0.01 and p = 0.001 in the CLET and AMT group, respectively). Independent samples T-test demonstrated a greater reduction in the CLET group (p = 0.028). Kaplan-Meier analysis of epithelialization demonstrated higher success rate in the CLET group (p = 0.006). Persistent corneal ulcers could be associated with partial limbal stem cell deficiency (LSCD). In refractory cases, CLET should be the preferred treatment option with more sustainable results regarding corneal epithelialization and stromal scarring.

摘要

这项研究比较了有和没有培养角膜缘上皮的羊膜移植治疗持续性角膜溃疡的临床效果。该研究包括30位仅接受人羊膜移植（AMT）或两步培养的带羊膜载体的角膜缘上皮移植（CLET）的患者。患者接受了全面的眼科检查，Cochet-Bonnet美学测量，印模细胞学检查和前段光学相干断层扫描（AS-OCT）。使用ImageJ分析治疗前后的裂隙灯图像，以比较纤维血管组织面积。在第30天通过荧光素染色评估上皮形成的状态。AMT组患者的平均年龄为64±20.39，CLET组患者的平均年龄为55.17±14.51（p = 0.16）。治疗后两组的视力均显着改善，但CLET组的视力显着提高（p  = 0.022）。印象细胞学检查显示，CLET组的9例患者和AMT组的10例患者的角膜上皮中有PAS +细胞（p  = 0.704）。治疗后，Cochet-Bonnet美学测定法显着增加，两组之间的比率相似（p  = 0.435）。两组均通过减少纤维血管组织面积实现了改善（ CLET组和AMT组分别为p  <0.01和p = 0.001）。独立样本T检验表明CLET组的降低更大（p = 0.028）。Kaplan-Meier的上皮细胞分析显示CLET组的成功率更高（p  = 0.006）。持续性角膜溃疡可能与部分角膜缘干细胞缺乏症（LSCD）有关。在难治性病例中，对于角膜上皮形成和基质瘢痕形成，CLET应该是首选的治疗方法，其结果更具可持续性。