眼表干细胞缺乏症患者应用巩膜镜治疗的临床效果及并发症
Clinical outcomes and complications of fluid-filled scleral lens devices for the management of limbal stem cell deficiency.
机构信息
Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA; Ophthalmology Department, Cochin Hospital, AP-HP, F-75014, Paris University, Paris, France.
Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA.
出版信息
Cont Lens Anterior Eye. 2023 Feb;46(1):101528. doi: 10.1016/j.clae.2021.101528. Epub 2021 Oct 30.
AIMS
To evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SL) wear in patients with limbal stem cell deficiency (LSCD).
DESIGN
Retrospective consecutive case series.
METHODS
27 eyes with LSCD confirmed by in vivo confocal microscopy at the Stein Eye Institute and fitted with SL were included. Correlations between corrected distance visual acuity (CDVA) and LSCD stage determined by clinical grading were performed between baseline (after the SL fit) and the last follow-up (the time of discontinuation of SL wear or the last visit in eyes in which SL were continued). In a subset of patients that had worsened LSCD while using SL, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed.
RESULTS
Baseline LSCD grading was stage I in 12 eyes (44.4%), stage 2 in 12 eyes (44.4%), and stage III in 3 eyes (11.1%). At the last follow-up, CDVA was improved in 7 eyes (25.9%), remained stable in 13 eyes (48.1%) and decreased in 7 eyes (25.9%, P = 0.16). The LSCD stage was improved in 7 eyes (25.9%), remained stable in 8 eyes (29.6%) and worsened in 12 eyes (44.4%, P = 0.10). AS-OCT and AS-FA, performed in 5 eyes, showed limbal compression and delayed fluorescein filling.
CONCLUSION
SL can improve visual acuity and maintain the ocular surface in the majority of eyes. Worsening of the ocular surface might be a result of limbal hypoxia. Close monitoring of SL fit is necessary in these compromised eyes.
目的
评估充满液体的巩膜镜片装置（SL）在边缘干细胞缺陷（LSCD）患者中的临床和视觉效果。
设计
回顾性连续病例系列。
方法
在 Stein 眼科研究所通过体内共聚焦显微镜确认 27 只患有 LSCD 的眼睛，并配备了 SL。在基线（SL 适配后）和最后一次随访（停止 SL 佩戴的时间或继续佩戴 SL 的眼睛的最后一次就诊）之间，对通过临床分级确定的 LSCD 阶段与矫正远视力（CDVA）之间进行相关性分析。在使用 SL 时 LSCD 恶化的患者亚组中，进行了眼前节光学相干断层扫描（AS-OCT）和眼前节荧光素血管造影（AS-FA）。
结果
基线 LSCD 分级为 1 期 12 只眼（44.4%），2 期 12 只眼（44.4%），3 期 3 只眼（11.1%）。在最后一次随访时，7 只眼（25.9%）的 CDVA 得到改善，13 只眼（48.1%）保持稳定，7 只眼（25.9%）下降（P=0.16）。LSCD 分期改善 7 只眼（25.9%），稳定 8 只眼（29.6%），恶化 12 只眼（44.4%）（P=0.10）。在 5 只眼中进行了 AS-OCT 和 AS-FA，显示出边缘压迫和荧光素填充延迟。
结论
SL 可以提高大多数眼睛的视力并维持眼表面。眼表面恶化可能是边缘缺氧的结果。在这些受损的眼睛中，需要密切监测 SL 的适配情况。
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