Shen Y, Xu J J, Le Q H
Department of Ophthalmology, Eye & ENT Hospital of Fudan University, NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai 200031, China.
Zhonghua Yan Ke Za Zhi. 2023 Jun 11;59(6):467-475. doi: 10.3760/cma.j.cn112142-20220627-00312.
To analyze the clinical features and treatment outcomes of eyes with contact lens-induced limbal stem cell deficiency (CL-iLSCD). This cross-sectional study involved patients diagnosed with CL-iLSCD at the Eye, Ear, Nose & Throat Hospital of Fudan University between October 2018 and September 2022. A total of 17 patients (25 eyes) with a mean age of (36.4±6.9) years were enrolled. Among them, 14 were females (82.4%). Corneal and limbal abnormalities, especially the range of epitheliopathy, were observed under a slit lamp biomicroscope with fluorescein staining. Anterior segment optical coherence tomography and laser scanning confocal microscopy were performed to obtain the central corneal epithelial thickness, density of basal epithelial cells and corneal nerve fiber length. The clinical features of CL-iLSCD, along with their treatment outcomes and related risk factors, were analyzed. All patients wore soft contact lenses, with an average daily wearing time of (10.5±2.5) hours and a median wearing duration of 10 (4 to 30) years. Ocular symptoms, including decreased vision, ocular discomfort or pain, redness, and photophobia, were present in 22 eyes (88.0%). The most characteristic clinical sign of CL-iLSCD was comb-or whorl-pattern late fluorescein staining under cobalt blue light, which was most commonly seen at the superior limbus (25/25, 100.0%). Additionally, reductions in central corneal epithelial thickness, basal cell density, and corneal nerve fiber length were observed. A comprehensive score was assigned to each eye based on clinical findings and imaging biomarkers. LSCD was mild, moderate, and severe in 5, 11, and 8 eyes, respectively. A history of misdiagnosis was found in 20 eyes (80.0%). After discontinuing the use of contact lenses and receiving medical treatment, significant improvement was observed in all eyes, with 13 eyes fully recovered. The symptoms and clinical signs of CL-iLSCD can be subtle at the early stage. Discontinuing contact lens wear and medication are effective to treat CL-iLSCD.
分析接触镜诱导的角膜缘干细胞缺乏（CL-iLSCD）患眼的临床特征及治疗效果。本横断面研究纳入了2018年10月至2022年9月期间在复旦大学附属眼耳鼻喉科医院被诊断为CL-iLSCD的患者。共纳入17例患者（25只眼），平均年龄为（36.4±6.9）岁。其中，女性14例（82.4%）。在裂隙灯生物显微镜下用荧光素染色观察角膜和角膜缘异常，尤其是上皮病变范围。进行眼前节光学相干断层扫描和激光扫描共聚焦显微镜检查，以获取中央角膜上皮厚度、基底上皮细胞密度和角膜神经纤维长度。分析CL-iLSCD的临床特征、治疗效果及相关危险因素。所有患者均佩戴软性接触镜，平均每日佩戴时间为（10.5±2.5）小时，佩戴时间中位数为10（4至30）年。22只眼（88.0%）出现视力下降、眼部不适或疼痛、眼红和畏光等眼部症状。CL-iLSCD最具特征性的临床体征是在钴蓝光下出现梳状或螺旋状晚期荧光素染色，最常见于上睑角膜缘（25/25，100.0%）。此外，还观察到中央角膜上皮厚度、基底细胞密度和角膜神经纤维长度降低。根据临床检查结果和影像生物标志物为每只眼赋予一个综合评分。5只眼、11只眼和8只眼的LSCD分别为轻度、中度和重度。20只眼（80.0%）有过误诊史。在停止使用接触镜并接受治疗后，所有患眼均有明显改善，13只眼完全恢复。CL-iLSCD的症状和临床体征在早期可能不明显。停止佩戴接触镜并进行药物治疗对治疗CL-iLSCD有效。
