Limbal transplantation at a tertiary hospital in Brazil: a retrospective study

ABSTRACTPurpose:Epidemiological analysis of limbal transplantation surgeries performed in the Ophthalmologic Hospital of Sorocaba.Methods:Retrospective medical records review of 30 patients who underwent limbal stem cell transplants between January 2003 and March 2008. Cases involving conjunctival limbal autograft were classified as group I, and those involving conjunctival limbal allograft as group II.Results:Two patients were excluded due to incomplete data during postoperative follow-up. Of the total sample of 28 patients, 53.6% constituted group I, whereas 46.4% were included in group II. Males were predominant (67.9%), and right eyes were the most prevalent (67.9%). The mean age was 40.3 years. Unilateral cases accounted for 60.7%. The most frequent pathology causing limbal system failure was chemical burns (53%). The mean length of time from diagnosis to surgery was 11.18 years. The limbal graft and amniotic membrane were associated in 75% of all cases, and tarsorrhaphy in 57.1%. The average follow-up period was 24.84 months. The uncorrected visual acuity improved in 38% of the cases, was unchanged in 28.5%, and deteriorated in 33.3%. There was no persistent epithelial defect in 75% of the patients. The conjunctivalization rate was similar between the groups (53.3% and 58.3%, respectively). The transparency improved in only 38.4% of the cases, and 28.5% of the surgeries performed were successful. The most prevalent complication was persistent epithelial defect, which occurred in 25% of the patients, followed by corneal melting in 14.2%. Other complications observed included infectious ulcers, limbal graft necrosis or ischemia, perforation, and descemetocele.Conclusion:Chemical burns remain the main cause of limbal stem cell deficiency. In these cases, limbal transplantation is the standard procedure to restore the ocular surface even though the success rate is low.摘要 研究目的：对索罗卡巴眼科医院开展的角膜缘移植手术进行流行病学分析。 研究方法：对2003年1月至2008年3月期间接受角膜缘干细胞移植的30例患者的病历资料进行回顾性审查。将接受结膜角膜缘自体移植（conjunctival limbal autograft）的病例归为I组，接受结膜角膜缘异体移植（conjunctival limbal allograft）的病例归为II组。 研究结果：2例患者因术后随访资料不全被排除。最终纳入分析的28例患者中，I组占比53.6%，II组占比46.4%。男性患者占多数（67.9%），右眼受累更为常见（67.9%）。患者平均年龄为40.3岁。单侧发病病例占60.7%。导致角膜缘功能衰竭的最常见病因是化学烧伤（53%）。从确诊至手术的平均间隔时间为11.18年。75%的病例联合应用了角膜缘移植物与羊膜（amniotic membrane），57.1%的病例实施了睑缘缝合术（tarsorrhaphy）。平均随访时长为24.84个月。裸眼视力（uncorrected visual acuity）得到改善的病例占38%，无变化的占28.5%，出现恶化的占33.3%。75%的患者未出现持续性上皮缺损（persistent epithelial defect）。两组的结膜化发生率相近（分别为53.3%与58.3%）。仅38.4%的病例角膜透明度得到改善，手术成功率为28.5%。最常见的并发症为持续性上皮缺损，发生率为25%，其次为角膜融解（corneal melting），发生率为14.2%。其他观察到的并发症包括感染性溃疡、角膜缘移植物坏死或缺血、穿孔以及后弹力层膨出（descemetocele）。 研究结论：化学烧伤仍是角膜缘干细胞缺乏症（limbal stem cell deficiency）的主要致病原因。此类病例中，尽管手术成功率较低，但角膜缘移植术仍是恢复眼表功能的标准治疗手段。