Estudio multicéntrico retrospectivo sobre trasplante de limbo

espanolObjetivo: Revisar el resultado de los trasplantes de limbo (TL) realizado en pacientes con Sindrome de insuficiencia limbica (SIL) en el contexto de varias enfermedades de la superficie ocular. Materiales y metodos: Se realizo un estudio retrospectivo y multicentrico (cinco centros) de los TL realizados entre 1996 y 2004. Los datos fueron recogidos por el mismo investigador, en una base de datos especialmente disenada para el estudio. Se considero como «exito» del TL a la ausencia de: defectos epiteliales, inflamacion y recurrencia del pterigion cuando este fue la causa del TL. Resultados: Se analizaron un total de 72 TL realizados en 61 pacientes (65 ojos) con tiempo de seguimiento de 20,8 meses (DS 23,5; rango, 3-115). Hubo 33 hombres y 28 mujeres, con una media de 55,8 anos (DS: 15,6; rango, 20-89). Se realizaron 58 (80.6%) TL autologos (40 pterigion, 12 causticaciones, tres iatrogenicas, dos infecciones virales, una neoplasia) y 14 (19,4%) TL alogenicos de donante cadaver (siete inflamaciones inmunes, seis causticaciones, uno iatrogenico). Todos los pacientes a los que se les realizo TL alogenicos recibieron inmunosupresion sistemica. Al final del seguimiento, 48 (66,7%) TL se consideraron un exito. Este porcentaje fue del 81,0% (47/58) en los TL autologos y del 7,1% (1/14) en los TL alogenicos. El porcentaje de exito tambien dependio de la etiologia, siendo alto en los casos de pterigion (80,0%) y menor en las patologias inmunologicas (14,3%). Conclusiones: El TL autologo es preferible al alogenico, pues la tasa de fracasos disminuye notablemente y, ademas, se evita el uso de inmunosupresion oral mantenida. Ademas, el pronostico es siempre peor en los casos de patologia inflamatoria inmune. El TL autologo parece ser una buena eleccion para el tratamiento del pterigion recurrente, aunque se necesitan estudios prospectivos que corroboren estos resultados. EnglishPurpose: To report the results of limbal transplantation (LT) in patients with limbal stem cell deficiency (LSCD) in the context of ocular surface diseases. Materials and methods: A multicenter (5 centers) retrospective case series analysis of patients who underwent LT between 1996 and 2004 was performed. Data were collected by the same researcher using a customized database. Success was defined by the absence of a persistent corneal epithelial defect, on-going inflammation or recurrence of a pterygium. Results: Data from 72 LT performed in 61 patients (65 eyes) with a mean follow-up of 20.8 months (SD 23.5; range, 3-115) were analyzed. There were 33 males and 28 females with a mean age of 55.8 years (SD: 15.6; range, 20-89). Fifty-eight (80.6%) LT were autografts (40 pterygia, 12 alkali burns, 3 iatrogenic cases, 2 viral infections, 1 neoplasia case) and 14 (19.4%) were allografts from cadaveric donors (7 immune-based disorders, 6 alkali burns, 1 iatrogenic case); all patients receiving allografts also received systemic immunosuppression. Of the total number of LT, 48 (66.7%) were successful. This proportion increased to 81.0% (47/58) when autografts were used. However, only 7.1% (1/14) of all allografts were successful. The success rate was higher (80.0%) when performed for a pterygium and lower when done for immune-based inflammation (14.3%). Conclusion: Autograft tissue for LT is always preferable to allografts to surgically treat LSCD, as clinical success is significantly higher, and systemic immunosuppression is avoided. As expected, immune-based disorders are the most difficult cases to treat. LT has been shown to be an excellent option for recurrent pterygium, although prospective studies need to be performed to further corroborate these results.