Tseng S C, Maumenee A E, Stark W J, Maumenee I H, Jensen A D, Green W R, Kenyon K R
Ophthalmology. 1985 Jun;92(6):717-27. doi: 10.1016/s0161-6420(85)33968-4.
We evaluated the clinical efficacy of treating various dry-eye disorders using 0.01% and 0.1% (weight/weight) topical all-trans retinoic acid ointment. Twenty-two patients were selected and classified into four major groups: keratoconjunctivitis sicca (6 patients; 11 eyes), Stevens-Johnson syndrome (9 patients; 17 eyes), ocular pemphigoid or drug-induced pseudopemphigoid (3 patients; 6 eyes), and surgery or radiation-induced dry eye (4 patients; 4 eyes), based on the criterion that they remained symptomatic even under maximum tolerable conventional medical and/or surgical therapies. The results indicated that squamous metaplasia with mucin deficiency secondary to goblet cell loss and keratinization may be the basis for the development of clinical symptoms and morbidities, as these epithelial abnormalities were invariably present before treatment. After treatment, all patients demonstrated clinical improvements in symptoms, visual acuity, rose Bengal staining, or Schirmer test. Most importantly, this topical vitamin A treatment caused the reversal of squamous metaplasia as evidenced by impression cytology. Therefore, this treatment may represent the first nonsurgical attempt to treat these disorders by reversing diseased ocular surface epithelium.
我们评估了使用0.01%和0.1%（重量/重量）的局部全反式维甲酸软膏治疗各种干眼症的临床疗效。选取了22名患者，并根据即使在最大耐受的传统药物和/或手术治疗下仍有症状这一标准，将他们分为四大组：干燥性角结膜炎（6例患者；11只眼）、史蒂文斯-约翰逊综合征（9例患者；17只眼）、眼部类天疱疮或药物性假类天疱疮（3例患者；6只眼）以及手术或放疗引起的干眼症（4例患者；4只眼）。结果表明，杯状细胞丧失和角化继发的伴有粘蛋白缺乏的鳞状化生可能是临床症状和发病的基础，因为这些上皮异常在治疗前总是存在。治疗后，所有患者在症状、视力、孟加拉玫瑰红染色或泪液分泌试验方面均有临床改善。最重要的是，这种局部维生素A治疗导致了鳞状化生的逆转，印片细胞学检查证明了这一点。因此，这种治疗可能代表了通过逆转患病的眼表上皮来治疗这些疾病的首次非手术尝试。
