Purpose

To evaluate the efficacy and outcome of simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD) using epithelial phenotype detection integrated with clinical manifestation.

Methods

This prospective multicenter study included patients with LSCD who underwent autologous SLET (autoSLET) and living-related allogenic SLET (Lr-alloSLET). All patients were assessed by slit-lamp biomicroscopy, in vivo confocal microscopy (IVCM), and impression cytology with immunofluorescence staining (ICIF) before and after surgery. The criteria for success were the presence of a clinically non-conjunctivalized cornea and corneal epithelium detected by IVCM or ICIF. Otherwise, the case would be considered a failure. Visual improvement and risk factors for SLET failure were analyzed.

Results

A total of 28 eyes of 26 patients (11 autoSLET and 17 Lr-alloSLET) were included. The median age was 53 years (range, 35–63), and the follow-up time was 29.5 months (range, 17.5–39.8). The overall survival rate was 89.3% at 2 years and 75.6% at 3 years with no difference between autoSLET and Lr-alloSLET (p = 0.24). Seven eyes subsequently underwent penetrating keratoplasty. Immunohistochemistry analysis showed that all corneal buttons had corneal epithelium and limbal stem cell markers. Visual improvement was achieved in both SLET groups (p < 0.001). Failed SLET developed between 5 and 32 months postoperatively. However, absolute risk factors for SLET failure were unidentified.

Conclusion

The efficacy of autoSLET and Lr-alloSLET for LSCD was excellent. Limbal explants can regenerate and restore the corneal surface while maintaining the characteristics of limbal stem cells as shown by epithelial phenotype detection and immunohistochemistry integrated with clinical evaluation.

中文翻译：

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上皮表型结合临床评价单纯角膜缘上皮移植治疗角膜缘干细胞缺陷的疗效及结局

目的

使用上皮表型检测结合临床表现评估简单角膜缘上皮移植 (SLET) 治疗角膜缘干细胞缺陷 (LSCD) 的疗效和结果。

方法

这项前瞻性多中心研究包括接受自体 SLET (autoSLET) 和活体相关同种异体 SLET (Lr-alloSLET) 的 LSCD 患者。所有患者在手术前后均通过裂隙灯生物显微镜、体内共聚焦显微镜 (IVCM) 和印迹细胞学免疫荧光染色 (ICIF) 进行评估。成功的标准是 IVCM 或 ICIF 检测到的临床非结膜角膜和角膜上皮的存在。否则，案件将被视为失败。分析了 SLET 失败的视觉改善和危险因素。

结果

共包括 26 名患者的 28 只眼（11 只 autoSLET 和 17 只 Lr-alloSLET）。中位年龄为 53 岁（范围，35-63），随访时间为 29.5 个月（范围，17.5-39.8）。2 年总生存率为 89.3%，3 年总生存率为 75.6%，autoSLET 和 Lr-alloSLET 之间没有差异（p = 0.24）。七只眼睛随后接受了穿透性角膜移植术。免疫组化分析显示所有角膜纽扣均具有角膜上皮和角膜缘干细胞标志物。两个 SLET 组都实现了视觉改善（p < 0.001）。术后 5 至 32 个月出现失败的 SLET。然而，SLET 失败的绝对危险因素尚未确定。

结论

autoSLET 和 Lr-alloSLET 对 LSCD 的疗效非常好。角膜缘外植体可以再生和恢复角膜表面，同时保持角膜缘干细胞的特征，如上皮表型检测和免疫组织化学结合临床评估所示。