Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
Can J Ophthalmol. 2018 Dec;53(6):574-579. doi: 10.1016/j.jcjo.2018.01.037. Epub 2018 Apr 2.
To describe conjunctival epithelial overgrowth of the cornea after surgery for glaucoma.
This is a retrospective case series (setting: Moorfields Eye Hospital). Fourteen eyes of 13 patients with suspected limbal stem cell deficiency (LSCD) and corneal conjunctivalization after glaucoma drainage surgery. Conjunctivalization was defined as corneal epithelium that demonstrated late stain after topical application of fluorescein. Patient demographics, clinical features, potential risk factors, treatment, and final visual acuity were recorded. Main outcome measures were potential risk factors for conjunctivalization, complications, and response to treatment.
Eleven eyes had multiple procedures involving the limbus, and in 11 eyes mitomycin C (MMC) or 5 fluorouracil had been used as an adjunct to reduce fibrosis. Affected eyes typically had a segment of late stain with fluorescein based at the site of previous glaucoma surgery, but in one eye there was total loss of the corneal epithelial phenotype. All eyes previously had topical treatment for their glaucoma but only 2 had an ocular surface disease associated with LSCD. Most cases were asymptomatic, but in 3 eyes there was visual loss when the abnormal phenotype crossed the visual axis. In these 3 eyes there was recurrent epithelial breakdown, often at the interface between the 2 epithelial phenotypes. In one individual, these symptoms resolved after limbal epithelial transfer from the unaffected contralateral eye.
Glaucoma drainage surgery can damage the adjacent corneal limbal epithelial stem cell population. This can be associated with recurrent epithelial breakdown and reduced vision. If there is visual loss, limbal epithelial transplantation is a potential treatment option.
描述青光眼手术后角膜结膜上皮过度生长。
这是一项回顾性病例系列研究（地点：莫尔菲尔德眼科医院）。对 13 例疑似角膜缘干细胞缺乏症（LSCD）和青光眼引流手术后角膜结膜化的患者的 14 只眼进行了研究。结膜化定义为角膜上皮在局部应用荧光素后表现出迟发性染色。记录了患者的人口统计学、临床特征、潜在危险因素、治疗和最终视力。主要观察指标为结膜化的潜在危险因素、并发症和治疗反应。
11 只眼有涉及角膜缘的多次手术，11 只眼使用丝裂霉素 C（MMC）或 5-氟尿嘧啶作为辅助治疗以减少纤维化。受影响的眼睛通常在先前青光眼手术部位有一段基于荧光素的迟发性染色，但在一只眼睛中角膜上皮表型完全丧失。所有受影响的眼睛以前都接受过治疗青光眼的局部治疗，但只有 2 只眼睛有与 LSCD 相关的眼表面疾病。大多数病例无症状，但在 3 只眼睛中，异常表型穿过视轴时出现视力丧失。在这 3 只眼睛中，上皮反复破裂，通常发生在 2 种上皮表型的交界处。在 1 名个体中，这些症状在从未受影响的对侧眼进行角膜缘上皮转移后得到缓解。
青光眼引流手术会损伤相邻角膜缘上皮干细胞群体。这可能与复发性上皮破裂和视力下降有关。如果出现视力丧失，角膜缘上皮移植是一种潜在的治疗选择。
