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Klin Monbl Augenheilkd 2002; 219(5): 333-339
DOI: 10.1055/s-2002-32637
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Strategien zur Behandlung der Limbusstammzellinsuffizienz

Surgical approaches for limbal stem cell deficiencyMartin  Grüterich1 , Scheffer  C. G.  Tseng2
  • 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine
  • 2Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida, USA
Experimentelle Ergebnisse dieser Arbeit wurden über ein Forschungsstipendium an M. G. der Deutschen Forschungsgemeinschaft (DFG), Bonn (GR 1814/1-1 und 1-2), unterstützt
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Publication History

14. 3. 2002

3. 5. 2002

Publication Date:
02 July 2002 (online)

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Zusammenfassung

Hintergrund: Die im basalen Limbusepithel lokalisierten Stammzellen des sich ständig erneuernden Epithels der Hornhaut können durch unterschiedliche Erkrankungen beeinträchtigt werden und so das klinische Bild der Limbusstammzellinsuffizienz (LI) hervorrufen. Das Hauptmerkmal der LI stellt die Konjunktivalisierung der Hornhautoberfläche dar. Verschiedene Strategien zum therapeutischen Vorgehen sollten berücksichtigt werden. Methoden und Ergebnisse: Erstes Ziel der Behandlung sollte die Wiederherstellung der Schutzmechanismen der Augenoberfläche sein, die einen stabilen Tränenfilm gewährleisten. Erst dann sollten weitere chirurgische Maßnahmen erfolgen. Zur Verfügung stehen die superfizielle Keratektomie mit oder ohne Amniontransplantation, die autologe Konjunktiva-Limbus-Transplantation und die homologe Kerato-Limbus-Transplantation. Destruktionen des Limbusstromas können mit Hilfe der Amniontransplantation therapeutisch angegangen werden. Tissue-engineering von Limbusepithel auf humaner Amnionmembran als biologischem Substrat und anschließender Transplantation stellt ein neues Verfahren zur Behandlung der LI dar. Schlussfolgerung: Die korrekte Diagnose sowie die Wiederherstellung der okulären Schutzmechanismen stellen die Grundvoraussetzung für die weitere chirurgische Rekonstruktion der Augenoberfläche dar. Trotz zum Teil sehr guter therapeutischer Ergebnisse sind weitere Untersuchungen zur Auswahl der Patienten für die zu wählende operative Technik sowie zur optimalen Immunsuppression erforderlich.

Abstract

Background: Stem cells are the ultimate source of the rapidly self-renewing corneal epithelium and are located in the basal layer of the limbal epithelium. A variety of diseases can compromise the stem cell pool, causing an entity called limbal stem cell deficiency. Several therapeutic strategies should be taken into account. Methods and results: Ocular surface defence should be restored prior to any kind of stem cell transplantation to assure a sufficient and stable tearfilm. Surgical strategies comprise superficial keratectomy with or without amniotic membrane transplantation, conjunctival-limbal autograft and keratolimbal allograft transplantation. A damaged limbal and corneal stroma can be reconstructed by amniotic membrane as a biological substrate. First encouraging results have been reported using tissue bio-engineered limbal epithelium on amniotic membrane for corneal surface reconstruction. Conclusion: The correct diagnosis and a restored ocular surface defence are a prerequisite for subsequent transplantation of limbal stem cells. Optimal patient selection for the respective surgical approach and systemic immunosuppression protocols to improve allograft survival need to be further investigated.

Schlüsselwörter

Limbusstammzellinsuffizienz - Impressionszytologie - Amnionmembran - Limbustransplantation - Stammzellen

Key words

Limbal stem cell deficiency - impression cytology - amniotic membrane - limbal stem cell transplantation - stem cells

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Scheffer C. G. Tseng,M. D., Ph. D. 

Ocular Surface Center and Ocular Surface Research & Education Foundation · 8780 SW

92nd Street

Miami, FL 33176 · USA

Email: stseng@ocularsurface.com