Burcu Ayse, Yalniz-Akkaya Zuleyha, Ozdemir Muhammet Fatih, Erdem Elif, Onat Mehmet Mustafa, Ornek Firdevs
Department of Ophthalmology, MH Ankara Training and Research Hospital , Ankara , Turkey and.
Cutan Ocul Toxicol. 2014 Mar;33(1):42-8. doi: 10.3109/15569527.2013.796477. Epub 2013 May 28.
The purpose of this study is to evaluate the management of limbal stem cell deficiency (LSCD) secondary to chemical ocular burns.
The charts of 48 eyes of 40 patients with grade 2 or higher chemical injury were evaluated retrospectively. Subjects with follow-up longer than 1 year were included. Medical treatment, surgical correction of abnormalities of ocular adnexial structures, limbal stem cell transplantation from patient's fellow eye, from living relatives or from cadaveric donor, amniotic membrane transplantation, conjunctival epitheliectomy, chelation with ethylenediaminetetraacetic acid and penetrating keratoplasty were the treatment modalities. Outcome measures were ocular surface stability and corrected distance visual acuity (CDVA). Failure was defined as the appearance of persistent epithelial defect (nonhealing epithelial defect for more than 2 weeks) with progressive corneal conjunctivalization/vascularization and thinning, and also progression of conjunctivalization to the central 6 mm of the cornea in eyes with subsequent keratoplasty.
The mean age of 31 male and 9 female patients were 32.32 ± 12.6 years. LSCD was bilateral in 8 cases. The mean follow-up was 77.2 ± 35.1 months. The presentations were in acute phase in 37.5%, in subacute phase in 32.5% and in chronic phase in 30% of the patients. Only 13 of 48 (27.1%) eyes obtained sufficient ocular surface stability through medical treatment; however, only 5 of these eyes achieved CDVA of less than 0.7 logMAR. Limbal stem cell transplantation was performed in 26 eyes as conjunctival limbal autograft, living-related conjunctival limbal allograft and keratolimbal allograft or as a combination of these transplantations. At the last visit, 30 eyes (62.5%) had an intact and stable ocular surface. Clear cornea was achieved in 11 (78.6%) of 14 eyes with grade 2 injury, in 9 (60%) of 15 eyes with grade 3 injury, in 5 (50%) of 10 eyes with grade 4 injury, in 1 (16.6%) of 6 eyes with grade 5 injury and in 1 (33.3%) of 3 eyes with grade 6 injury. The CDVA that was 1.66 ± 0.99 logMAR initially improved to 0.87 ± 0.85 logMAR at the last visit (p < 0.001).
While patients with low-grade chemical injury seem to benefit quite well from the medical treatment, amniotic membrane transplantation, limbal graft transplantation and subsequent keratoplasty; patients with severe injuries seem to be more prone to failure after all of the available treatment modalities.
本研究旨在评估化学性眼烧伤继发的角膜缘干细胞缺乏（LSCD）的治疗方法。
回顾性分析40例2级或更高级别化学伤患者的48只眼的病历。纳入随访时间超过1年的患者。治疗方式包括药物治疗、眼附属器结构异常的手术矫正、取自患者健眼、活体亲属或尸体供体的角膜缘干细胞移植、羊膜移植、结膜上皮切除术、乙二胺四乙酸螯合治疗及穿透性角膜移植术。观察指标为眼表稳定性和矫正远视力（CDVA）。失败定义为出现持续性上皮缺损（上皮缺损不愈合超过2周），伴有角膜结膜化/血管化及角膜变薄进展，以及在后续角膜移植眼中结膜化进展至角膜中央6mm区域。
31例男性和9例女性患者的平均年龄为32.32±12.6岁。8例患者为双侧LSCD。平均随访时间为77.2±35.1个月。37.5%的患者处于急性期，32.5%处于亚急性期，30%处于慢性期。48只眼中仅13只（27.1%）通过药物治疗获得了足够的眼表稳定性；然而，这些眼中只有5只眼的CDVA小于0.7 logMAR。26只眼进行了角膜缘干细胞移植，包括结膜角膜缘自体移植、活体亲属结膜角膜缘异体移植和角膜角膜缘异体移植，或这些移植方式的联合应用。在最后一次随访时，30只眼（62.5%）具有完整且稳定的眼表。14只2级损伤眼中11只（78.6%）角膜透明，15只3级损伤眼中9只（60%）角膜透明，10只4级损伤眼中5只（50%）角膜透明，6只5级损伤眼中1只（16.6%）角膜透明，3只6级损伤眼中1只（33.3%）角膜透明。初始CDVA为1.66±0.99 logMAR，在最后一次随访时改善至0.87±0.85 logMAR（p<0.001）。
轻度化学伤患者似乎能从药物治疗、羊膜移植、角膜缘移植及后续角膜移植中获益；而重度损伤患者在所有可用治疗方式后似乎更容易失败。
