Objective: To investigate the therapeutic effects of autologous corneal limbal stem cells transplantation for treatment of pterygium,to approach the method to reduce postoperative recurrence rate.Methods: Pterygium excision combined with autologous limbal stem cell transplantation was performed on 24 cases(28 eyes) with primary pterygium group or recurrent pterygium group. Special attention was paid to the corneal bed during separation and to the accurate aligment of the graft. The post-operative follow-up varied from 6 months to 36 months. The difference of visual acuity between preoperation and postoperation,the postoperative healing time of corneal epithelium,and the recurrence rate was observed.The result was analysed statistically.Result: The visual acuity of most cases(78.6%)was promoted. The visual acuity of 13 cases,14 eyes were promoted one line,and the visual acuity of 6 cases,8 eyes were promoted two lines by <WP=27>visual acuity chart 7 days after operation.The healing of corneal epithelial and autograft taked 3.1 days and 5-7 days respectively,all of which were stable. 1 of 28 eyes(3.57%) was found recurrence 2 months after operation. Between primary pterygium group and recurrent pterygium group,there was significant difference in visual acuity promotion,and significant difference was not presumed in the corneal epithelium healing time and the recurrence rate.No complication was found in and after operation.Conclusion:Autologous corneal limbal stem cells transplantation is an effective and safe treatment for primary and recurrent pterygium.1.Pterygium is a condition charaterised by a triangular or wing-shaped overgrowth of abnormal conjunctiva onto the cornea,and it is prevalent in periequatorial and tropical regions.The cause is still unkown,but the close relation between pterygium and ultraviolet ray is accepted widely.The coexistence of degeneration and proliferation is the pathological feature.Although many surgical approaches have been developed,the recurrence of pterygium presents a significant surgical problem. Clinical and <WP=28>laboratory evidence indicates that corneal stem cells(LSC) are located at the limbus,and are thought to play a key role in maintain ocular surface structure and function stabilization.LSC is not only the origin of corneal epithium,but also the barrier between conjunctiva and cornea. Limbal deficiency, or loss of LSC, is associated with conjunctivalisation of corneal surface,and the occurrence of pterygium. When harm factors(e.g.ultraviolet ray)affect LSC and local microenvironment directly or indirectly,the barrier between conjunctiva and cornea is destroyed.As a result,conjunctiva tissue extend excessively to cornea,and pterygium occurs.To treat pterygium,the reconstruction of limbal barrier are required.2.It was revealed from this study that pterygium excision combined with autologous limbal stem cells transplantation was a safe and effective treatment. The promotion of the visual acuity was due to the removal of pterygium tissue in pupil area(12 cases,12 eyes),or lightening astigmatism.The corneal epithium healing was of off-center,for epithelium <WP=29>originate from adjacent corneal epithelium basal cell and limbal graft.As a result,it taked less time to heal.1 case,1 eye was found recurrence two months after operation,for the graft did not match the cornea raw surface,merely 2/3 of the latter.3.The operation must be well considered and cautious,which is the key of reducing complication and recurrence.In conclusion,autologous corneal limbal stem cells transplantation was useful to the treatment of pterygium.
↧