Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.
Am J Ophthalmol. 2013 Mar;155(3):544-549.e2. doi: 10.1016/j.ajo.2012.09.013. Epub 2012 Dec 4.
To describe characteristics of patients with severe limbal stem cell deficiency associated with contact lens (CL) wear.
Retrospective case series.
Database search of patients with severe limbal stem cell deficiency related to CL wear was conducted. The charts of 12 patients (18 eyes) were reviewed. Outcome measures included patient demographics, CL type, duration of wear, indications for wear, symptoms, location and laterality of limbal stem cell deficiency, coexisting ocular disease, and treatment.
Mean patient age at presentation was 42 years (range, 19 to 58 years), and 8 patients (67%) were female. Mean duration of CL wear was 14.1 years (range, 1 to 20 years), 6 patients (50%) had bilateral disease, and all wore soft CLs for refractive error correction. Vision was decreased to a mean of 20/78 (range, 20/30 to 20/250) in all eyes. Fifteen eyes (83%) had photophobia, pain, or both. Findings leading to the diagnosis included whorl-like epitheliopathy, corneal conjunctivalization, and late fluorescein staining of the involved epithelium for at least 6 clock hours. On average, 10 clock hours (range, 6 to 12 clock hours) were involved, and 11 eyes (61%) had total ocular involvement. Conservative treatments failed in all eyes. Fourteen eyes (78%) underwent limbal stem cell transplantation with systemic immunosuppression.
Severe limbal stem cell deficiency related to CL wear is a clinical diagnosis that an ophthalmologist should recognize. Female patients, soft CLs, and extended duration of wear time are associated with this condition. Conservative measures may not reverse the disease, and limbal stem cell transplantation with systemic immunosuppression is a surgical option for these young and healthy patients.
描述与接触镜（CL）佩戴相关的严重角膜缘干细胞缺乏症患者的特征。
回顾性病例系列。
对与 CL 佩戴相关的严重角膜缘干细胞缺乏症患者进行数据库搜索。回顾了 12 名患者（18 只眼）的图表。观察指标包括患者人口统计学特征、CL 类型、佩戴时间、佩戴指征、症状、角膜缘干细胞缺乏症的位置和侧别、共存眼病以及治疗。
患者就诊时的平均年龄为 42 岁（范围，19 至 58 岁），8 名患者（67%）为女性。CL 佩戴时间的平均长度为 14.1 年（范围，1 至 20 年），6 名患者（50%）患有双侧疾病，所有人均佩戴软性 CL 以矫正屈光不正。所有眼睛的视力均下降至平均 20/78（范围，20/30 至 20/250）。15 只眼睛（83%）有畏光、疼痛或两者兼有。导致诊断的发现包括轮状上皮病、角膜结膜化和受累上皮至少 6 个时钟小时的晚期荧光素染色。平均受累 10 个时钟小时（范围，6 至 12 个时钟小时），11 只眼睛（61%）有全部眼部受累。所有眼睛的保守治疗均失败。14 只眼睛（78%）接受了带全身免疫抑制的角膜缘干细胞移植。
与 CL 佩戴相关的严重角膜缘干细胞缺乏症是眼科医生应认识的一种临床诊断。女性患者、软性 CL 和佩戴时间延长与这种情况有关。保守措施可能无法逆转疾病，对于这些年轻健康的患者，角膜缘干细胞移植和全身免疫抑制是一种手术选择。
