Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK; Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK; Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Ocul Surf. 2021 Jul;21:1-15. doi: 10.1016/j.jtos.2021.04.005. Epub 2021 Apr 23.
Alcohol (ethanol) has been used in medicine since time immemorial. In ophthalmic practice, besides as an antiseptic, it was given as retrobulbar injections to relieve severe ocular pain. Alcohol can be applied topically to the surface of neoplastic or suspicious lesions to kill cells that might desquamate and seed during surgical excision, to treat epithelial ingrowth that can occur following corneal surgeries, particularly laser in situ keratomileusis (LASIK), and to treat superficial infectious keratitis. In view of its ability to achieve a smooth cleavage plane between the epithelium and the Bowman's layer, alcohol-assisted delamination (ALD) of the corneal epithelium has been used widely and effectively for a variety of diagnostic and therapeutic indications, at times delivering both outcomes. Diagnostically, ALD yields an intact epithelial sheet which can be fixed flat to provide excellent orientation for histopathological evaluation. Therapeutically, it is most commonly used to treat recurrent corneal erosion syndrome, where its efficacy is comparable to that of phototherapeutic keratectomy but with several advantages. It has also been used to treat various forms of epithelial/anterior stromal dystrophies, which can obviate or delay the need for corneal transplantation for several years. In addition, ALD is performed in corneal collagen cross-linking and corneal refractive surgery for relatively atraumatic removal of the epithelium. In this review, we aimed to provide a comprehensive overview of the diagnostic and therapeutic use of topical alcohol in ophthalmology, to describe the surgical and fixation techniques of ALD, and to highlight our experience in ALD over the past decade.
酒精（乙醇）自古以来就在医学中得到应用。在眼科实践中，除了作为防腐剂外，它还被用作球后注射，以缓解严重的眼部疼痛。酒精可以局部应用于肿瘤或可疑病变的表面，以杀死可能在手术切除过程中脱落和播散的细胞，治疗角膜手术后（特别是激光原位角膜磨镶术 [LASIK]）可能发生的上皮内长入，以及治疗浅层感染性角膜炎。鉴于其在表皮和 Bowman 层之间形成光滑分裂面的能力，酒精辅助分层（ALD）已广泛有效地用于各种诊断和治疗适应证，有时可同时获得两种效果。在诊断方面，ALD 产生完整的上皮片，可以固定平坦，为组织病理学评估提供极好的方向。在治疗方面，它最常用于治疗复发性角膜糜烂综合征，其疗效与光疗性角膜切除术相当，但具有一些优势。它还被用于治疗各种形式的上皮/前基质营养不良，这可以避免或延迟数年需要进行角膜移植。此外，在角膜胶原交联和角膜屈光手术中，ALD 用于相对无创地去除上皮。在这篇综述中，我们旨在全面概述眼科中局部应用酒精的诊断和治疗用途，描述 ALD 的手术和固定技术，并强调我们在过去十年中在 ALD 方面的经验。
