Schrader Stefan, Wedel Thilo, Moll Ralf, Geerling Gerd
Department of Ophthalmology, UK-SH Campus Lübeck, Klinik für Augenheilkunde, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Graefes Arch Clin Exp Ophthalmol. 2006 Oct;244(10):1345-9. doi: 10.1007/s00417-006-0257-y. Epub 2006 Mar 17.
The treatment of persistent epithelial defects (PED) with autologous serum eye drops is often combined with conventional medication such as artificial tears and topical antibiotics, but until now no report exists on the use of a bandage contact lens (BCL) in combination with autologous serum eye drops in the treatment of PEDs. We report six eyes (five patients) which were all treated with autologous serum eye drops in combination with an FDA group IV hydrogel contact lens.
Five patients aged 36-88 years, were suffering from six PEDs for 73.5+/-46.9 days due to rheumatoid sterile corneal ulcer (n=1), neurotrophic keratopathy (n=3) or partial limbal stem cell deficiency (n=1). All patients had been unsuccessfully treated with conventional therapy before. Three of them had already had an amniotic membrane transplantation and two had undergone a keratoplasty; however, the epithelial defect persisted or recurred. In all cases, an FDA group IV hydrogel contact lens (Biomedics 55, ocufilcon D, 55% water content) was fitted and serum eye drops applied 8 times a day.
The PED healed in five of six eyes after a treatment period of 14.2+/-8.9 days. In one eye the PED became smaller, but it took 90 days until the lesion healed completely. In three eyes (two patients) white deposits appeared on the surface of the BCL during the treatment after 12.3+/-5.1 days. Because no signs of inflammation were observed and since the epithelial defect improved, a new identical lens was applied and the medication continued unaltered. The surface of contaminated and non-contaminated BCLs were analyzed by scanning electron microscopy and SDS gel-electrophoresis. The scanning electron microscopic examination presented a coating of amorphous material with a wrinkled appearance and many corpuscular deposits. There was no indication of bacterial colonisation. The SDS gel-electrophoresis showed a small band at 65 kDa, probably albumin.
These findings suggest that the combination of a therapeutic contact lens and serum eye drops can be successfully used in the treatment of persistent epithelial defects. Deposition of albumin may occur on the surface of the contact lenses, which, in the small group presented here, caused no unwanted effects.
自体血清滴眼液治疗持续性上皮缺损（PED）时，常与人工泪液和局部抗生素等传统药物联合使用，但迄今为止，尚无关于绷带式隐形眼镜（BCL）与自体血清滴眼液联合用于治疗PED的报道。我们报告了6只眼（5例患者），均采用自体血清滴眼液联合美国食品药品监督管理局（FDA）IV类水凝胶隐形眼镜进行治疗。
5例年龄在36 - 88岁的患者，因类风湿性无菌性角膜溃疡（1例）、神经营养性角膜病变（3例）或部分角膜缘干细胞缺乏（1例），患有6处PED，病程为73.5±46.9天。所有患者此前接受传统治疗均未成功。其中3例已行羊膜移植，2例行角膜移植；然而，上皮缺损持续存在或复发。所有病例均佩戴FDA IV类水凝胶隐形眼镜（Biomedics 55，ocufilcon D，含水量55%），并每天使用8次血清滴眼液。
经过14.2±8.9天的治疗期后，6只眼中有5只眼的PED愈合。1只眼中PED变小，但病变完全愈合耗时90天。3只眼（2例患者）在治疗12.3±5.1天后，BCL表面出现白色沉积物。由于未观察到炎症迹象且上皮缺损有所改善，故更换了新的相同镜片，并继续使用原药物。通过扫描电子显微镜和十二烷基硫酸钠（SDS）凝胶电泳对被污染和未被污染的BCL表面进行分析。扫描电子显微镜检查显示有一层外观呈皱纹状且有许多颗粒状沉积物的无定形物质涂层。未发现细菌定植迹象。SDS凝胶电泳显示在65 kDa处有一条小条带，可能是白蛋白。
这些发现表明，治疗性隐形眼镜与血清滴眼液联合使用可成功用于治疗持续性上皮缺损。白蛋白可能会沉积在隐形眼镜表面，在本研究的小样本中，这并未产生不良影响。
