Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ophthalmology. 2011 Jul;118(7):1272-81. doi: 10.1016/j.ophtha.2010.11.012. Epub 2011 Mar 12.
To report the clinical findings and compare outcomes of different surgical techniques evolved over time in a large series of patients with delayed-onset mustard gas keratitis (MGK).
Retrospective, comparative, interventional case series.
Ninety Iranian male survivors (175 eyes) of Iraqi chemical warfare with chronic or delayed-onset MGK.
The symptoms and clinical findings of patients are presented, and medical and surgical interventions to address dry eye, limbal ischemia and limbal stem cell deficiency (LSCD), and corneal involvements are explained. The results of limbal stem cell transplantation techniques (living-related conjunctival-limbal allograft [lrCLAL] versus keratolimbal allograft [KLAL]) as well as corneal transplantation techniques (penetrating keratoplasty [PK] versus lamellar keratoplasty [LK]) are compared in terms of clinical outcomes and graft survival rates.
Ocular findings and appropriate surgical approach for LSCD and corneal involvements.
A total of 175 eyes of 90 cases (all male) between 34 and 68 years of age were followed up for 101±30.3 months (range, 36-198 months). The most common ocular involvements were chronic blepharitis and dry eye. Conjunctival vascular abnormalities and limbal ischemia were observed in 27.4% and 29.7% of eyes, respectively. Limbal stem cell deficiency necessitating stem cell transplantation developed in 41.1% of eyes. The most common corneal sign was central and peripheral anterior stromal opacity (58.9%), followed by corneal stromal thinning (36.0%) and neovascularization (27.4%). Living-related conjunctival-limbal allograft was performed in 32 eyes, and KLAL was performed in 40 eyes. The rejection-free graft survival rate was 39.1% in the lrCLAL group and 80.7% in the KLAL group at month 40, with a mean length of 24.9 and 68.8 months, respectively (P = 0.02). Thirty eyes underwent PK and 51 underwent LK. Corneal graft failure was observed in 9 PK eyes and in 6 LK eyes. The rejection-free graft survival rate was 39.0% in the PK group and 90.3% in the LK group at month 28, with a mean length of 29.6 and 85.0 months, respectively (P<0.001).
Chemical warfare victims who initially have mild symptoms ultimately may experience significant ocular involvements requiring surgical intervention. Limbal and corneal abnormalities can be managed best by KLAL and LK, respectively.
报告在一系列患有迟发性氮芥角膜炎（MGK）的患者中，随着时间的推移，不同手术技术的临床发现和比较结果。
回顾性、比较性、干预性病例系列。
90 名伊朗男性幸存者（175 只眼）患有慢性或迟发性氮芥性角膜炎（MGK），他们是伊拉克化学战的受害者。
介绍了患者的症状和临床发现，并解释了针对干眼症、角膜缘缺血和角膜缘干细胞缺乏症（LSCD）以及角膜受累的医疗和手术干预措施。比较了角膜缘干细胞移植技术（活体相关结膜-角膜缘同种异体移植术 [lrCLAL]与角膜缘同种异体移植术 [KLAL]）和角膜移植技术（穿透性角膜移植术 [PK]与板层角膜移植术 [LK]）的临床结果和移植物存活率。
LSCD 和角膜受累的眼部发现和适当的手术方法。
90 例（均为男性）中共有 175 只眼，年龄在 34 至 68 岁之间，随访时间为 101±30.3 个月（范围 36-198 个月）。最常见的眼部受累是慢性睑缘炎和干眼症。27.4%的眼睛出现结膜血管异常，29.7%的眼睛出现角膜缘缺血。41.1%的眼睛出现需要干细胞移植的角膜缘干细胞缺乏症。最常见的角膜征象是中央和周边前基质混浊（58.9%），其次是角膜基质变薄（36.0%）和新生血管形成（27.4%）。32 只眼行活体相关结膜-角膜缘同种异体移植术，40 只眼行 KLAL。第 40 个月时，lrCLAL 组的无排斥移植物存活率为 39.1%，KLAL 组为 80.7%，平均长度分别为 24.9 和 68.8 个月（P=0.02）。30 只眼行 PK，51 只眼行 LK。9 只 PK 眼和 6 只 LK 眼发生角膜移植失败。第 28 个月时，PK 组的无排斥移植物存活率为 39.0%，LK 组为 90.3%，平均长度分别为 29.6 和 85.0 个月（P<0.001）。
最初症状轻微的化学战受害者最终可能会出现需要手术干预的严重眼部受累。KLAL 和 LK 分别是治疗角膜缘和角膜异常的最佳方法。
