Офтальмохирургия. 2019; : 77-86
Клеточная хирургия при дисфункции стволовых клеток лимба
https://doi.org/10.25276/0235-4160-2019-1-77-86Аннотация
В обзоре представлена новая хирургическая методика реконструкции эпителия роговицы и результаты её применения у пациентов с односторонним синдромом лимбальной недостаточности (СЛН) роговицы ожоговой этиологии, заключающаяся в выкраивании фрагмента верхнего лимба размерами 2×2 мм интактного глаза, подготовке глаза реципиента с СЛН, фрагментировании и размещении полученных фрагментов (в количестве 8-10) на амнионе и фиксацию последнего фибриновым клеем к строме роговицы. Новый тип аутолимбальной трансплантации отличает ткане-сохраняющий подход и высокие результаты, сопоставимые с трансплантацией аутологичных культивированных лимбальных эпителиальных клеток. В ходе ряда исследований показано, что операция модифицированной лимбальной аутотрансплантации является эффективной и воспроизводимой. Она обеспечивает долговременный эффект, заключающийся в эпителизации роговицы у 72-80% и увеличение остроты зрения у 72-75% пациентов с односторонним синдромом лимбальной недостаточности роговицы ожоговой этиологии в зависимости от возраста пациента и сопутствующей патологии.
Список литературы
1. Davanger M., Evensen A. Role of the pericorneal psapillary Structure in renewal of corneal epithelium. Nature. 1971;229(5286): 560-561. Available from: doi. org/10.1038/229560a0.
2. Schermer A. Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells. J. Cell Biol. 1986;103(1): 49-62. Available from: https:// doi.org/10.1083/jcb.103.1.49.
3. Dua H.S., Saini J.S., Azuara-Blanco A., Gupta P. Limbal stem cell deficiency: concept, aetiology, clinical presentation, diagnosis and management. Indian J. Ophthalmol. 2000;48(2): 83-92.
4. Puangsricharern V., Tseng S.C. Cytologlogic evidence of corneal diseases with limbal stem cell deficiency. Ophthalmology. 1995;102(10):1476¬1485. Available from: https://doi.org/10.1016/S0161- 6420(95)30842-1.
5. Sacchetti M., Lambiase A., Cortes M. et al. Clinical and cytological findings in limbal stem cell deficiency. Graefes Arch. Clin. Exp. Ophthalmol. 2005;243(9): 870¬876. Available from: https://doi.org/10.1007/s00417- 005-1159-0.
6. Deng S., Sejpal K., Bakhtiari P. Presentation, diagnosis and management of limbal stem cell deficiency. Middle East Afr. J. Ophthalmol. 2013;20(1): 5-10. Available from: https://doi.org/10.4103/0974- 9233.106381.
7. Lim P., Fuchsluge, T.A., Jurkunas U.V. Limbal stem cell deficiency and corneal neovascularization. Semin. Ophthalmol. 2009;24(3): 139-148. Available from: https://doi.org/10.1080/08820530902801478.
8. Holland E.J. Management of limbal stem cell deficiency: a historical perspective, past, present, and future. Cornea. 2015;34 Suppl. 10:S9-15. Available from: https://doi.org/10.1097/lC0.0000000000000534.
9. Thoft R.A. Conjunctival transplantation. Arch. Ophthalmol. 1977;95(8): 1425-1427. Available from: https://doi.org/10.1001/archopht.1977.04450080135017.
10. Kenyon K.R., Tseng S.C. Limbal asutograft transplantation for ocular surface disorders. Ophthalmology. 1989;96(5): 709-723. Available from: https://doi.org/10.1016/S0161-6420(89)32833-8.
11. Tsai R.J., Tseng S.C. Human allograft limbal transplantation for corneal surface reconstruction. Cornea. 1994;13(5): 389-400. Available from: https:// doi.org/10.1097/00003226-199409000-00003.
12. Kwitko S., Marinho D., Barcaro S. et al. Allograft conjunctival transplantation for bilateral ocular surface disorders. Ophthalmology. 1995;102(7): 1020¬1025. Available from: https://doi.org/10.1016/S0161- 6420(95)30918-9.
13. Tsubota K., Toda l., Saito H. et al. Reconstruction of the corneal epithelium by limbal allograft transplantation for severe ocular surface disorders. Ophthalmology. 1995;102(10): 1486-1496. Available from: https://doi.org/10.1016/S0161-6420(95)30841-X.
14. Biber J.M., Skeens H.M., Neff K.D., Holland E.J. The Cincinnati procedure: technique and outcomes of combined living-related conjunctival limbal allografts and keratolimbal allografts in severe ocular surface failure. Cornea. 2011;30(7): 765-771. Available from: https://doi.org/10.1097/lCO.0b013e318201467c.
15. Movahedan A., Cheung A.Y., Eslani M. et al. Long-term outcomes of ocular surface stem cell allograft transplantation. Am. J. Ophthalmol. 2017;184: 97-107. Available from: https://doi.org/10.1016/j. ajo.2017.10.002.
16. Holland E.J., Mogilishetty G., Skeens H.K. et al. Systemic immunosuppression in ocular surface stem cell transplantation: results of a 10-year experience. Cornea. 2012;31(6): 655-661. Available from: https:// doi.org/10.1097/lCO.0b013e31823f8b0c.
17. Sangwan V.S., Basu S., MacNeil S., Balasubramanian D. Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency. Br. J. Ophthalmol. 2012;96(7): 931-934. Available from: https://doi.org/10.1136/bjophthalmol-2011-301164.
18. Basu S., Sureka S.P., Shanbhag S.S. et al. Simple limbal epithelial transplantation: long-term clinical outcomes in 125 cases of unilateral chronic ocular surface burns. Ophthalmology. 2016;123(5): 1000¬1010. Available from: https://doi.org/10.1016/j. ophtha.2015.12.042.
19. Vazirani J., Ali M.H., Sharma N. et al. Autologous simple limbal epithelial transplantation for unilateral limbal stem cell deficiency: multicentre results. Br. J. Ophthalmol. 2016;100(10): 1416-1420. Available from: https://doi.org/10.1136/bjophthalmol-2015-307348.
20. Amescua G., Atallah M., Nikpoor N. et al. Modified simple limbal epithelial transplantation using cryopreserved amniotic membrane for unilateral limbal stem cell deficiency. Am. J. Ophthalmol. 2014;158(3): 469-475.e2. Available from: https://doi.org/10.1016/j. ajo.2014.06.002.
21. Queiroz A.G., Barbosa M.M., Santos M.S. et al. Assessment of surgical outcomes of limbal transplantation using simple limbal epithelial transplantation technique in patients with total unilateral limbal deficiency. Arq. Bras. Oftalmol. 2016;79(2): 116-118. Available from: https://doi.org/10.5935/0004-2749.20160034.
22. Hernandez-Bogantes E., Amescua G., Navas A. et all. Minor ipsilateral simple limbal epithelial transplantation (mini-SLET) for pterygium treatment. Br. J. Ophthalmol. 2015;99(12): 1598-1600. Available from: https://doi.org/10.1136/bjophthalmol-2015-306857.
23. Mittal V., Narang P., Menon V. et al. Primary simple limbal epithelial transplantation along with excisional biopsy in the management of extensive ocular surface squamous neoplasia. Cornea. 2016;35(12): 1650-1652. Available from: https://doi.org/10.1097/ lCO.0000000000000953.
24. Kaliki S., Mohammad F.A., Tahiliani P., Sangwan V.S. Concomitant simple limbal epithelial transplantation after surgical excision of ocular surface squamous seoplasia. Am. J. Ophthalmol. 2017;174: 68-75. Available from: https://doi.org/10.1016/j.ajo.2016.10.021.
25. Busin M., Breda C., Bertolin M. et al. Corneal epithelial stem cells repopulate the donor area within 1 year from limbus removal for limbal autograft. Ophthalmology. 2016;123(12): 2481-2488. Available from: https://doi.org/10.1016/j.ophtha.2016.08.018.
26. Arora R., Dokania P., Manudhane A., Goyal J.L. Preliminary results from the comparison of simple limbal epithelial transplantation with conjunctival limbal autologous transplantation in severe unilateral chronic ocular burns. lndian J Ophthalmol. 2017;65(1): 35-40. Available from: https://doi.org/10.4103/0301- 4738.202312.
27. Singh D., Vanathi M., Gupta C. et al. Outcomes of deep anterior lamellar keratoplasty following autologous simple limbal epithelial transplant in pediatric unilateral severe chemical injury. lndian J. Ophthalmol. 2017;65(3): 217-222. Available from: https://doi.org/10.4103/ijo. lJO_880_16.
28. Baradaran-Rafii A., Eslani M., Haq Z. et al. Current and upcoming therapies for ocular surface chemical injuries. Ocul. Surf. 2017;15(1): 48-64. Available from: https://doi.org/10.1016/j.jtos.2016.09.002.
29. Yeung A.M., Faraj L.A., Mclntosh O.D. et al. Fibrin glue inhibits migration of ocular surface epithelial cells. Eye (Lond.). 2016;30(10): 1389-1394. Available from: https://doi.org/10.1038/eye.2016.127.
30. Fomichev D., Kalinin P., Gavrushin A. Endoscopic transnasal transclival resection of endodermal cyst on ventral surface of brainstem. World Neurosurg. 2017;97: 756.e7-756.e11. Available from: https://doi. org/10.1016/j.wneu.2016.10.024.10.10.2017.
31. Beierlein W., Scheule A. M., Antoniadis G. et al. An immediate, allergic skin reaction to aprotinin after reexposure to fibrin sealant. Transfusion. 2000;40(3): 302-305. Available from: https://doi.org/10.1046/j.1537- 2995.2000.40030302.x.
32. Geerling G., Maclennan S., Hartwig D. Autologous serum eye drops for ocular surface disorders. Br. J. Ophthalmol. 2004;88(11): 1467-1474. Available from: https://doi.org/10.1136/bjo.2004.044347.
33. Kjaergard H.K., Weis-Fogh U.S., S rensen H. et al. Autologous fibrin glue - preparation and clinical use in thoracic surgery. Eur. J. Cardio-Thoracic Surg. 1992;6(1): 52-54. Available from: https://doi.org/10.1016/1010- 7940(92)90100-C.
34. Rauz S., Saw V.P. Serum eye drops, amniotic membrane and limbal epithelial stem cells - tools in the treatment of ocular surface disease. Cell Tissue Bank. 2010;11(1): 13-27. Available from: https://doi. org/10.1007/s10561-009-9128-1.
Fyodorov Journal of Ophthalmic Surgery. 2019; : 77-86
Simple limbal epithelial transplantation (a literature review)
https://doi.org/10.25276/0235-4160-2019-1-77-86Abstract
The review presents a new surgical approach and its clinical results for corneal epithelial reconstruction in patients with unilateral limbal stem cell deficiency (LSCD) of burn etiology. Simple limbal epithelial transplantation (SLET) is a novel surgical technique of limbal transplantation.
SLET uses the healthy eye as a donor source for dissection of a 2×2 mm strip of limbal tissue, gluing an amniotic membrane after preparation the recipient contralateral ocular surface, distributing and gluing eight to ten small pieces of limbal tissue over an amniotic membrane. The new type of grafting utilizes tissue-preserving approach and as effective as transplantation of cultivated autologous limbal epithelial stem cells. Clinical finding demonstrated its efficiency, safety, and reproducibility. SLET provides a long-term reconstruction of the corneal epithelium for patients with unilateral LSCD in approximately 72-80% and a visual acuity improvement 72-75% of appropriately selected patients depending on age and eye co-morbidity.
References
1. Davanger M., Evensen A. Role of the pericorneal psapillary Structure in renewal of corneal epithelium. Nature. 1971;229(5286): 560-561. Available from: doi. org/10.1038/229560a0.
2. Schermer A. Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells. J. Cell Biol. 1986;103(1): 49-62. Available from: https:// doi.org/10.1083/jcb.103.1.49.
3. Dua H.S., Saini J.S., Azuara-Blanco A., Gupta P. Limbal stem cell deficiency: concept, aetiology, clinical presentation, diagnosis and management. Indian J. Ophthalmol. 2000;48(2): 83-92.
4. Puangsricharern V., Tseng S.C. Cytologlogic evidence of corneal diseases with limbal stem cell deficiency. Ophthalmology. 1995;102(10):1476¬1485. Available from: https://doi.org/10.1016/S0161- 6420(95)30842-1.
5. Sacchetti M., Lambiase A., Cortes M. et al. Clinical and cytological findings in limbal stem cell deficiency. Graefes Arch. Clin. Exp. Ophthalmol. 2005;243(9): 870¬876. Available from: https://doi.org/10.1007/s00417- 005-1159-0.
6. Deng S., Sejpal K., Bakhtiari P. Presentation, diagnosis and management of limbal stem cell deficiency. Middle East Afr. J. Ophthalmol. 2013;20(1): 5-10. Available from: https://doi.org/10.4103/0974- 9233.106381.
7. Lim P., Fuchsluge, T.A., Jurkunas U.V. Limbal stem cell deficiency and corneal neovascularization. Semin. Ophthalmol. 2009;24(3): 139-148. Available from: https://doi.org/10.1080/08820530902801478.
8. Holland E.J. Management of limbal stem cell deficiency: a historical perspective, past, present, and future. Cornea. 2015;34 Suppl. 10:S9-15. Available from: https://doi.org/10.1097/lC0.0000000000000534.
9. Thoft R.A. Conjunctival transplantation. Arch. Ophthalmol. 1977;95(8): 1425-1427. Available from: https://doi.org/10.1001/archopht.1977.04450080135017.
10. Kenyon K.R., Tseng S.C. Limbal asutograft transplantation for ocular surface disorders. Ophthalmology. 1989;96(5): 709-723. Available from: https://doi.org/10.1016/S0161-6420(89)32833-8.
11. Tsai R.J., Tseng S.C. Human allograft limbal transplantation for corneal surface reconstruction. Cornea. 1994;13(5): 389-400. Available from: https:// doi.org/10.1097/00003226-199409000-00003.
12. Kwitko S., Marinho D., Barcaro S. et al. Allograft conjunctival transplantation for bilateral ocular surface disorders. Ophthalmology. 1995;102(7): 1020¬1025. Available from: https://doi.org/10.1016/S0161- 6420(95)30918-9.
13. Tsubota K., Toda l., Saito H. et al. Reconstruction of the corneal epithelium by limbal allograft transplantation for severe ocular surface disorders. Ophthalmology. 1995;102(10): 1486-1496. Available from: https://doi.org/10.1016/S0161-6420(95)30841-X.
14. Biber J.M., Skeens H.M., Neff K.D., Holland E.J. The Cincinnati procedure: technique and outcomes of combined living-related conjunctival limbal allografts and keratolimbal allografts in severe ocular surface failure. Cornea. 2011;30(7): 765-771. Available from: https://doi.org/10.1097/lCO.0b013e318201467c.
15. Movahedan A., Cheung A.Y., Eslani M. et al. Long-term outcomes of ocular surface stem cell allograft transplantation. Am. J. Ophthalmol. 2017;184: 97-107. Available from: https://doi.org/10.1016/j. ajo.2017.10.002.
16. Holland E.J., Mogilishetty G., Skeens H.K. et al. Systemic immunosuppression in ocular surface stem cell transplantation: results of a 10-year experience. Cornea. 2012;31(6): 655-661. Available from: https:// doi.org/10.1097/lCO.0b013e31823f8b0c.
17. Sangwan V.S., Basu S., MacNeil S., Balasubramanian D. Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency. Br. J. Ophthalmol. 2012;96(7): 931-934. Available from: https://doi.org/10.1136/bjophthalmol-2011-301164.
18. Basu S., Sureka S.P., Shanbhag S.S. et al. Simple limbal epithelial transplantation: long-term clinical outcomes in 125 cases of unilateral chronic ocular surface burns. Ophthalmology. 2016;123(5): 1000¬1010. Available from: https://doi.org/10.1016/j. ophtha.2015.12.042.
19. Vazirani J., Ali M.H., Sharma N. et al. Autologous simple limbal epithelial transplantation for unilateral limbal stem cell deficiency: multicentre results. Br. J. Ophthalmol. 2016;100(10): 1416-1420. Available from: https://doi.org/10.1136/bjophthalmol-2015-307348.
20. Amescua G., Atallah M., Nikpoor N. et al. Modified simple limbal epithelial transplantation using cryopreserved amniotic membrane for unilateral limbal stem cell deficiency. Am. J. Ophthalmol. 2014;158(3): 469-475.e2. Available from: https://doi.org/10.1016/j. ajo.2014.06.002.
21. Queiroz A.G., Barbosa M.M., Santos M.S. et al. Assessment of surgical outcomes of limbal transplantation using simple limbal epithelial transplantation technique in patients with total unilateral limbal deficiency. Arq. Bras. Oftalmol. 2016;79(2): 116-118. Available from: https://doi.org/10.5935/0004-2749.20160034.
22. Hernandez-Bogantes E., Amescua G., Navas A. et all. Minor ipsilateral simple limbal epithelial transplantation (mini-SLET) for pterygium treatment. Br. J. Ophthalmol. 2015;99(12): 1598-1600. Available from: https://doi.org/10.1136/bjophthalmol-2015-306857.
23. Mittal V., Narang P., Menon V. et al. Primary simple limbal epithelial transplantation along with excisional biopsy in the management of extensive ocular surface squamous neoplasia. Cornea. 2016;35(12): 1650-1652. Available from: https://doi.org/10.1097/ lCO.0000000000000953.
24. Kaliki S., Mohammad F.A., Tahiliani P., Sangwan V.S. Concomitant simple limbal epithelial transplantation after surgical excision of ocular surface squamous seoplasia. Am. J. Ophthalmol. 2017;174: 68-75. Available from: https://doi.org/10.1016/j.ajo.2016.10.021.
25. Busin M., Breda C., Bertolin M. et al. Corneal epithelial stem cells repopulate the donor area within 1 year from limbus removal for limbal autograft. Ophthalmology. 2016;123(12): 2481-2488. Available from: https://doi.org/10.1016/j.ophtha.2016.08.018.
26. Arora R., Dokania P., Manudhane A., Goyal J.L. Preliminary results from the comparison of simple limbal epithelial transplantation with conjunctival limbal autologous transplantation in severe unilateral chronic ocular burns. lndian J Ophthalmol. 2017;65(1): 35-40. Available from: https://doi.org/10.4103/0301- 4738.202312.
27. Singh D., Vanathi M., Gupta C. et al. Outcomes of deep anterior lamellar keratoplasty following autologous simple limbal epithelial transplant in pediatric unilateral severe chemical injury. lndian J. Ophthalmol. 2017;65(3): 217-222. Available from: https://doi.org/10.4103/ijo. lJO_880_16.
28. Baradaran-Rafii A., Eslani M., Haq Z. et al. Current and upcoming therapies for ocular surface chemical injuries. Ocul. Surf. 2017;15(1): 48-64. Available from: https://doi.org/10.1016/j.jtos.2016.09.002.
29. Yeung A.M., Faraj L.A., Mclntosh O.D. et al. Fibrin glue inhibits migration of ocular surface epithelial cells. Eye (Lond.). 2016;30(10): 1389-1394. Available from: https://doi.org/10.1038/eye.2016.127.
30. Fomichev D., Kalinin P., Gavrushin A. Endoscopic transnasal transclival resection of endodermal cyst on ventral surface of brainstem. World Neurosurg. 2017;97: 756.e7-756.e11. Available from: https://doi. org/10.1016/j.wneu.2016.10.024.10.10.2017.
31. Beierlein W., Scheule A. M., Antoniadis G. et al. An immediate, allergic skin reaction to aprotinin after reexposure to fibrin sealant. Transfusion. 2000;40(3): 302-305. Available from: https://doi.org/10.1046/j.1537- 2995.2000.40030302.x.
32. Geerling G., Maclennan S., Hartwig D. Autologous serum eye drops for ocular surface disorders. Br. J. Ophthalmol. 2004;88(11): 1467-1474. Available from: https://doi.org/10.1136/bjo.2004.044347.
33. Kjaergard H.K., Weis-Fogh U.S., S rensen H. et al. Autologous fibrin glue - preparation and clinical use in thoracic surgery. Eur. J. Cardio-Thoracic Surg. 1992;6(1): 52-54. Available from: https://doi.org/10.1016/1010- 7940(92)90100-C.
34. Rauz S., Saw V.P. Serum eye drops, amniotic membrane and limbal epithelial stem cells - tools in the treatment of ocular surface disease. Cell Tissue Bank. 2010;11(1): 13-27. Available from: https://doi. org/10.1007/s10561-009-9128-1.
