角膜上皮幹細胞疲弊症における異なる外科的技法の臨床的転帰

This study aimed to evaluate the long-term outcomes of limbal stem cell deficiency (LSCD) treated with various limbal stem cell transplantation (LSCT) techniques.

This retrospective study included 32 eyes of 29 patients who underwent LSCT. Clinical evaluation was performed based on preoperative and postoperative best corrected visual acuity (BCVA, logarithm of the minimum angle of resolution [logMAR]), degree of corneal neovascularization, extent of corneal involvement, and clarity of the central visual axis. Human leukocyte antigen (HLA) compatibility in allograft recipients was assessed via HLA tissue typing. The Kruskal-Wallis and Wilcoxon tests were used to compare variables between groups.

A total of 84.4% (n=27) of the eyes had LSCD secondary to chemical injury. Median preoperative and postoperative BCVA (logMAR) values were 2.1 and 1.8 (p=0.01) in the conjunctival limbal allograft (CLAL) group (n=22; 18 living-related, 4 deceased donors), 0.9 and 0.7 (p=0.11) in the conjunctival limbal autograft (CLAU) group (n=4), and 2.1 and 1.3 (p=0.04) in the simple limbal epithelial transplantation (SLET) group (n=6; 3 autografts, 3 allografts), respectively. There was no statistically significant difference in BCVA improvement between groups. Median clinical scores improved from 10 to 6 in the CLAL group (p<0.001), from 7 to 4 in the CLAU group (p=0.11), and from 10 to 3 in the SLET group (p=0.03). Preoperatively, a statistically significant difference in clinical scores was observed only between the CLAU and SLET groups (p=0.029); however, no significant difference was found between groups postoperatively. HLA compatibility was 75% in 15 eyes that received living-related CLAL, and 100% in all 3 eyes that underwent allogeneic SLET.

Different LSCT techniques may be applied in LSCD depending on the underlying etiology and extent of involvement. Favorable outcomes can also be achieved with allogeneic approaches when HLA compatibility is ensured.