CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
Am J Ophthalmol. 2020 Sep;217:297-304. doi: 10.1016/j.ajo.2020.05.001. Epub 2020 May 11.
To compare outcomes of management in the early stage of severe chemical injury (grade 4 and worse; Dua classification) with amniotic membrane grafting (AMG) alone vs allogenic simple limbal epithelial transplantation (alloSLET).
Retrospective comparative interventional case series.
Retrospective comparative interventional series. Records of patients with severe ocular chemical injury who underwent AMG alone (between 2009 and 2013) vs alloSLET (between 2013 and 2017) were analyzed for grade of injury, time of and interventions for epithelial healing, ocular surface status post healing (grade of symblepharon, and limbal stem cell deficiency [LSCD]), and type of and need for interventions in the chronic stage.
Among patients presenting in early stage of severe chemical injury, 38 eyes (median age 11 years) managed with AMG alone were compared with 39 eyes (median age 8 years) managed with alloSLET. The mean time of presentation post injury was 33.85 ± 27.5 and 40.6 ± 23.5 days in the AMG and alloSLET group, respectively. The rate of epithelial healing was faster in the alloSLET group and the difference was noted to be statistically significant (odds ratio [OR] 0.966, P = .001). Similarly, the lower occurrence of LSCD (OR 0.137, P = .004) and need for keratoplasty (OR 0.093, P = .003) favored alloSLET over AMG. Final best-corrected visual acuity of >20/200 was achieved in 39.4% and 53.8% in the AMG and alloSLET groups, respectively.
AlloSLET helps in faster epithelialization of the surface, thus reducing the need for subsequent surgeries in the chronic stage and aiding faster visual rehabilitation. The outcomes of alloSLET appear superior to amniotic membrane grafting alone and should be considered in eyes with grade 4 and above (Dua classification) chemical injuries in the early stage.
比较严重化学性损伤（Dua 分级 4 级及以上）早期阶段单纯羊膜移植（AMG）与同种异体单纯性 limbal 上皮移植（alloSLET）的治疗效果。
回顾性对比干预性病例系列研究。
回顾性对比干预性病例系列研究。分析了 2009 年至 2013 年间接受 AMG 治疗的严重眼部化学性损伤患者（n=38 例）和 2013 年至 2017 年间接受 alloSLET 治疗的患者（n=39 例）的眼部损伤分级、上皮愈合时间和干预措施、愈合后眼表状况（包括睑球粘连程度和 limbal 干细胞缺乏症 [LSCD]）以及慢性期的干预类型和需求。
在早期严重化学性损伤患者中，38 只眼（中位年龄 11 岁）接受 AMG 治疗，39 只眼（中位年龄 8 岁）接受 alloSLET 治疗。两组患者损伤后就诊的平均时间分别为 33.85±27.5 和 40.6±23.5 天。alloSLET 组上皮愈合更快，差异具有统计学意义（比值比 [OR] 0.966，P=0.001）。同样，LSCD 发生率较低（OR 0.137，P=0.004）和需要角膜移植的比例较低（OR 0.093，P=0.003），这也表明 alloSLET 优于 AMG。AMG 组和 alloSLET 组的最终最佳矫正视力>20/200 者分别占 39.4%和 53.8%。
alloSLET 有助于更快地使表面上皮化，从而减少慢性期后续手术的需求，加速视力康复。alloSLET 的治疗效果优于单纯 AMG，应考虑用于早期 Dua 分级 4 级及以上的化学性损伤眼。
