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Autologe Transplantation von kultiviertem Limbusepithel

Autologous transplantation of cultivated limbal epithelium

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Zusammenfassung

Hintergrund

In dieser Studie soll die Wirksamkeit der Ex-vivo-Expansion von autologem Limbusepithel zur Oberflächenrekonstruktion bei limbaler Stammzellinsuffizienz (LSZI) untersucht werden.

Patienten und Methoden

Bei 30 Augen von 28 Patienten (m:w 22:6) mit einer kompletten (n=18) oder partiellen (n=12) LSZI erfolgte eine autologe Transplantation von kultiviertem Limbusepithel. Folgende Ätiologien einer LSZI wurden behandelt: Verätzungen/Verbrennungen (n=16), Pterygium (n=9), Z. n. Tumorexzision (n=2), Z. n. Perforationstrauma, Mitomycin-C-induzierte LSZI, und Epidermolysis bullosa, (jeweils n=1). Nur Augen mit einem Nachbeobachtungszeitraum von mindestens 9 Monaten wurden in die Studie eingeschlossen.

Ergebnisse

Der Nachbeobachtungszeitraum betrug im Mittel 28,9±15,5 Monate. Ein stabiles okuläres Oberflächenepithel wurde bei 23 Augen (76,7%) erzielt. Die Sehschärfe stieg bei 21 Augen (70%) an, war stabil bei 8 Augen (26,7%) und verschlechterte sich bei einem Auge (3,3%). Der durchschnittliche LogMAR-Visus verbesserte sich signifikant (p<0,0001) von präoperativ 1,58±0,97 zu postoperativ 0,6±0,49.

Diskussion

Transplantation von ex-vivo-expandiertem Limbusepithel führt zur Stabilisierung des kornealen Oberflächenepithels und zu einem signifikanten Visusgewinn. Autologe Verfahren haben auch nach Langzeitbeobachtung eine sehr gute Prognose.

Abstract

Objective

In this study the clinical outcome of ex vivo expansion of autologous limbal epithelial cells on intact amniotic membranes (AM) for ocular surface reconstruction in limbal stem cell deficiency (LSCD) was investigated.

Patients and Methods

A total of 30 eyes in 28 patients (22 male and 6 female) with total (n=18) or partial (n=12) LSCD were treated by transplantation of autologous limbal epithelial cells after expansion on intact AM. The causes of LSCD in the patients were chemical and thermal burns (n=16), pterygium (n=9), tumor excision (n=2), perforating injury, mitomycin C-induced LSCD and epidermolysis bullosa (each n=1). Only eyes with a follow-up time of at least 9 months were included in the analysis. The main outcome criteria were restoration of ocular surface integrity and improvement of visual acuity (VA).

Results

The mean follow-up time was 28.9±15.5 months. An entirely stable corneal surface was reconstructed in 23 (76.7%) eyes. Visual acuity increased significantly in 21 (70%) eyes, was stable in 8 (26.7%) eyes and decreased in 1 (3.3%) eye. The mean visual acuity increased significantly (p<0.0001) from a preoperative value of 1.58±0.97 LogMAR to 0.6±0.49 LogMAR.

Conclusion

Transplantation of limbal epithelium cultivated on intact AM restores a stable corneal surface and results in a significant increase in visual acuity in most cases of LSCD. Autologous transplantation of cultivated limbal epithelium showed an excellent prognosis and outcome after long-term follow-up.

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Authors and Affiliations

  1. Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universität Duisburg-Essen, 45122, Essen, Deutschland

    D. Meller, M. Pauklin, H. Westekemper & K.-P. Steuhl

  2. Universitäts-Augenklinik, Universitätsklinikum Tartu, Tartu, Estland

    M. Pauklin

Authors
  1. D. Meller
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  2. M. Pauklin
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  3. H. Westekemper
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  4. K.-P. Steuhl
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Corresponding author

Correspondence to D. Meller.

Additional information

Beide Autoren (DM, MK) haben gleichen Anteil an der Studie und sollten als Erstautoren gewertet werden.

Unterstützt mit Drittmitteln der estnischen Forschungsgemeinschaft (ETF Grant 5832); der Deutschen Ophthalmologischen Gesellschaft (DOG); der Deutschen Forschungsgemeinschaft (DFG, Bonn, ME 1623/3–1) und der Forschungsförderung AG Trockenes Auge (Berlin, Deutschland).

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Meller, D., Pauklin, M., Westekemper, H. et al. Autologe Transplantation von kultiviertem Limbusepithel. Ophthalmologe 107, 1133–1138 (2010). https://doi.org/10.1007/s00347-010-2205-9

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