Long-term results of allogeneic penetrating limbo-keratoplasty in total limbal stem cell deficiency.
| Autor: | Reinhard T; Eye Hospital, Albert-Ludwigs University, Killianstrasse 5, 79106 Freiburg, Germany. Reinhard@aug.ukl.uni-freiburg.de, Spelsberg H, Henke L, Kontopoulos T, Enczmann J, Wernet P, Berschick P, Sundmacher R, Böhringer D |
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| Jazyk: | angličtina |
| Zdroj: | Ophthalmology [Ophthalmology] 2004 Apr; Vol. 111 (4), pp. 775-82. |
| DOI: | 10.1016/j.ophtha.2003.07.013 |
| Abstrakt: | Objective: To determine the prognosis of allogeneic penetrating limbo-keratoplasty in patients with total limbal stem cell deficiency and to find out if donor limbal stem cells survive in the long run. Design: Noncomparative prospective case series. Participants: Forty-eight patients with total limbal stem cell deficiency. Intervention: Allogeneic penetrating limbo-keratoplasty. All patients received systemic cyclosporin A and/or mycophenolate mofetil in the postoperative course. Thirteen patients received grafts with 0 to 1 HLA mismatches in the HLA-A, HLA-B, and HLA-DR loci; 13 patients received grafts with 2 to 6 mismatches; and 22 patients received untyped grafts. Main Outcome Measures: Long-term clear graft survival and survival of donor limbal stem cells. Results: Five years postoperatively, 65% of the grafts with 0 to 1 mismatches, 41% of the grafts with 2 to 6 mismatches, and 14% of the untyped grafts were clear centrally (estimation according to Kaplan-Meier log rank test, P = 0.03). Immunogenetic analysis of epithelial cells from the surface of the graft could be performed successfully in 7 of 9 patients and revealed donor DNA in the epithelium of 5 of these 7 patients up to 56 months postoperatively. Conclusions: Long-term survival of donor epithelium could be demonstrated immunogenetically in patients undergoing allogeneic penetrating limbo-keratoplasty. Human leukocyte antigen-matched grafts seem to deliver better results than untyped grafts. Progress with matching and immunosuppressive strategies may further improve current results. |
| Databáze: | MEDLINE |
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