گزارش سه مورد پيوند آلوگرافت بافت ليمبوس ازدهنده زنده در جانبازان شيميايي

Limbal Cell Allografts from Live Sibling Donors for Treatment of Chemical Warfare Ocular Injuries

Exposure to Chemical Warfare (CW) agents such as mustard sulfur results in bilateral destructive impact of the corneal surface and limbus not responsive to long-term medical therapy. Allograft limbal transplantation (ALT) is a promising surgical method for these situations. The purpose of this study was to evaluate the intermediate-term outcome in CW patient. We performed and evaluated allograft ALT from live patients siblings into three eyes of two patients with severe delayed mustard sulfur keratopathy HLA matching was not performed and to avoid allograft rejection, low dose oral cyclosporine was prescribed. We followed our patients for 15 months. HLA-unmatched allograft ALT in all of three eyes resulted in restoration of a stable ocular surface with early visual rehabilitation, tearing system improvement and significant reduction in symptoms (photophobia, pain, itching, and redness). Visual acuity imporoved from hand motion to 2/10--6110. No side effect from cyclosporine were seen to date. Features of graft rejection were not seen in the patients. Although more cases and longer follow-up is needed, but the outcome was satisfactory in three eyes. It seems that ALT from live sibling donors may be an effective surgical technique to treatment of bilateral delayed mustard sulfur keratopathy.