Cincinnati Eye Institute/University of Cincinnati, Cincinnati, OH.
Virginia Eye Consultants, Norfolk, VA.
Cornea. 2023 Sep 1;42(9):1063-1068. doi: 10.1097/ICO.0000000000003322. Epub 2023 Jun 8.
To highlight the paucity of surgeons performing ocular surface stem cell transplantation with systemic immunosuppression (OSSTx with SI) for limbal stem cell deficiency (LSCD) patients, suboptimal treatments for LSCD, and obstacles to adoption.
A review of the Eye Bank Association of America annual reports and the authors' case volume for OSSTx with SI was performed. Examination of the published literature on corneal surgeries, especially for LSCD, was completed. These findings were combined with our clinical observations to develop this editorial.
Despite techniques and protocols for OSSTx with SI published more than 30 years ago for the treatment of severe bilateral LSCD, only a small number of corneal specialists have adopted these techniques. There is a paucity of attention to this population of patients, with minimal publications to advance this area of our field. We are too often referred patients with LSCD and severe ocular surface disease that have had suboptimal treatments such as penetrating keratoplasties or primary keratoprostheses. Hesitancy for adopting OSSTx with SI is likely due to a lack of exposure to these procedures during training and fear of systemic immunosuppression. Corneal surgeons are likely unaware of the safety of systemic immunosuppression with appropriate monitoring especially when comanaging these patients with an organ transplant specialist.
There is a large unmet need for the treatment of corneal blindness secondary to conjunctival and LSCD. For the vast majority of patients, OSSTx should be the first surgical choice to treat these eyes. We hope major ophthalmology centers will meet this need by building programs, and groups of corneal surgeons should collaborate to create regional centers to make this treatment more accessible to help this population.
强调进行眼表干细胞移植联合全身免疫抑制（OSSTx 联合 SI）治疗角膜缘干细胞缺乏症（LSCD）患者的外科医生数量较少，LSCD 的治疗效果并不理想，以及采用该治疗方法存在障碍。
对美国眼库协会的年度报告和作者进行的 OSSTx 联合 SI 病例数量进行了回顾。对角膜手术，特别是 LSCD 的相关文献进行了研究。将这些发现与我们的临床观察相结合，编写了这篇社论。
尽管 30 多年前就发表了用于治疗严重双侧 LSCD 的 OSSTx 联合 SI 技术和方案，但只有少数角膜专家采用了这些技术。对这部分患者的关注度较低，该领域的相关出版物也很少。我们经常接诊 LSCD 及严重眼表疾病的患者，这些患者接受的治疗并不理想，如穿透性角膜移植术或原发性角膜成形术。由于在培训过程中缺乏对这些手术的接触，以及对全身免疫抑制的恐惧，因此对采用 OSSTx 联合 SI 犹豫不决。角膜外科医生可能没有意识到在适当监测下使用全身免疫抑制的安全性，特别是当与器官移植专家共同管理这些患者时。
由于结膜和 LSCD 导致的角膜盲的治疗需求巨大，但尚未得到满足。对于绝大多数患者来说，OSSTx 应该是治疗这些眼睛的首选手术方法。我们希望主要的眼科中心能够通过建立项目来满足这一需求，并且角膜外科医生群体应该合作建立区域性中心，使这种治疗方法更容易获得，从而帮助这部分患者。
