Shen Carl, Chan Clara C, Holland Edward J
University of Toronto Medical School, Toronto, Canada.
Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio.
Am J Ophthalmol. 2015 Dec;160(6):1142-1149.e1. doi: 10.1016/j.ajo.2015.07.038. Epub 2015 Aug 20.
To describe the outcomes of limbal stem cell transplantation in eyes with limbal stem cell deficiency related to soft contact lens wear.
Retrospective interventional case series.
Institutional database search at the Cincinnati Eye Institute revealed 9 patients (14 eyes) who underwent limbal stem cell transplantation with systemic immunosuppression for soft contact lens wear-related limbal stem cell deficiency. Outcome measures included patient demographics, symptoms, best-corrected visual acuity, ocular surface stability, adverse events, and additional surgeries required.
Average patient age at time of surgery was 46.6 ± 11.1 years (range 20-60 years). Average duration of follow-up was 28 ± 19.1 months (range 12-70 months). Preoperative best-corrected visual acuity (BCVA) was 20/40 or worse in all eyes (average 20/70, range 20/40-20/250) and patient symptoms included foreign body sensation, tearing, redness, and/or pain. Four eyes (29%) underwent living-related conjunctival limbal allograft and 10 eyes (71%) underwent cadaver-donor keratolimbal allograft surgery. Topical and systemic immunosuppression was used in all patients. At final follow-up after limbal stem cell transplantation, there was a stable ocular surface in 12 of 14 eyes (86%) and improvement in BCVA to 20/30 or better and complete resolution of patient symptoms in all except 1 patient who had significant rosacea blepharokeratoconjunctivitis, whose BCVA remained at 20/150 and 20/60, in right and left eyes, respectively. The most common adverse event was an increase in intraocular pressure in 8 of 14 eyes (57%), requiring topical antiglaucoma treatment. Ten of 14 eyes (71%) underwent cataract extraction related to topical steroid use. No eyes required subsequent penetrating keratoplasty.
Limbal stem cell transplantation is a viable option for the management of soft contact lens wear-related limbal stem cell deficiency in young healthy patients. Early intervention prior to subepithelial fibrosis can lead to good visual outcomes with no need for subsequent cornea transplant. Co-management with a solid organ transplant specialist is helpful for the monitoring and management of systemic adverse events related to patient systemic immunosuppression.
描述针对与软性隐形眼镜佩戴相关的角膜缘干细胞缺乏症患者进行角膜缘干细胞移植的结果。
回顾性干预病例系列研究。
对辛辛那提眼科学院机构数据库进行检索，发现9例患者（14只眼）因软性隐形眼镜佩戴相关的角膜缘干细胞缺乏症接受了角膜缘干细胞移植并接受全身免疫抑制治疗。观察指标包括患者人口统计学资料、症状、最佳矫正视力、眼表稳定性、不良事件以及所需的额外手术。
手术时患者的平均年龄为46.6±11.1岁（范围20 - 60岁）。平均随访时间为28±19.1个月（范围12 - 70个月）。所有患眼术前最佳矫正视力（BCVA）均为20/40或更差（平均20/70，范围20/40 - 20/250），患者症状包括异物感、流泪、眼红和/或疼痛。4只眼（29%）接受了活体亲属结膜角膜缘移植，10只眼（71%）接受了尸体供体角膜缘移植手术。所有患者均使用了局部和全身免疫抑制治疗。在角膜缘干细胞移植后的最终随访中，14只眼中有12只眼（86%）眼表稳定，除1例患有严重酒渣鼻性睑缘角膜结膜炎的患者外，其余患者的最佳矫正视力均提高到20/30或更好，且患者症状完全缓解，该例患者右眼和左眼的最佳矫正视力分别仍为20/150和20/60。最常见的不良事件是14只眼中有8只眼（57%）眼压升高，需要局部抗青光眼治疗。14只眼中有10只眼（71%）因局部使用类固醇而接受了白内障摘除术。没有患眼需要后续的穿透性角膜移植术。
对于年轻健康患者中与软性隐形眼镜佩戴相关的角膜缘干细胞缺乏症，角膜缘干细胞移植是一种可行的治疗选择。在发生上皮下纤维化之前进行早期干预可带来良好的视力预后，无需后续角膜移植。与实体器官移植专科医生共同管理有助于监测和处理与患者全身免疫抑制相关的全身不良事件。
