Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Türkiye.
Turk J Ophthalmol. 2024 Oct 25;54(5):251-256. doi: 10.4274/tjo.galenos.2024.69705.
To evaluate the clinical characteristics and treatment strategies of limbal stem cell deficiency (LSCD) patients managed with medical therapy.
The study included 29 eyes of 21 patients with LSCD who were managed medically at Ege University Faculty of Medicine, Department of Ophthalmology between May 2013 and May 2023. LSCD stages before and after medical treatment were recorded according to the LSCD staging system published by the International LSCD Working Group. The medical records of patients showing improvement in LSCD stage with medical treatment without surgical intervention were evaluated.
The mean age was 35.5±23.8 years (range, 5-71 years) with a male-to-female ratio of 6:15. The primary etiology of LSCD was ocular rosacea in 12 patients (57.1%), marginal keratitis in the setting of blepharitis in 8 patients (38.1%), and topical medication toxicity in 1 patient (4.8%). The mean baseline best corrected visual acuity (BCVA) was 0.25±0.26 logarithm of the minimum angle of resolution (logMAR) (range, 0-1 logMAR). Pre-treatment LSCD stage was stage 1A in 5 eyes (17.2%), stage 1B in 12 eyes (41.4%), stage 1C in 4 eyes (13.8%), stage 2A in 4 eyes (13.8%), and stage 2B in 4 eyes (13.8%). Complete regression of LSCD was achieved in 6 eyes (20.7%) with medical treatment addressing the primary etiology. In the remaining eyes, after medical treatment, the severity of LSCD decreased below the surgical threshold, which is considered stage 2B. The mean final BCVA was 0.07±0.1 logMAR (range, 0-0.4 logMAR).
This study highlights that LSCD can be completely or partially reversible with appropriate management, especially in cases with underlying limbal niche dysfunction, where inflammation plays a significant role. Although limbal stem cell transplantation is considered the main treatment approach for LSCD, localized and early-stage LSCD can be effectively managed medically without the need for surgical intervention.
评估接受药物治疗的角膜缘干细胞缺乏症（LSCD）患者的临床特征和治疗策略。
本研究纳入了 2013 年 5 月至 2023 年 5 月期间在伊兹密尔艾大学医学院眼科接受药物治疗的 21 例 29 只眼 LSCD 患者。根据国际 LSCD 工作组发布的 LSCD 分期系统，记录 LSCD 分期在药物治疗前后的变化。评估未行手术干预而仅通过药物治疗改善 LSCD 分期的患者的病历。
患者的平均年龄为 35.5±23.8 岁（5-71 岁），男女比例为 6:15。LSCD 的主要病因包括：12 例（57.1%）为眼型酒渣鼻，8 例（38.1%）为伴有睑缘炎的边缘性角膜炎，1 例（4.8%）为局部用药毒性。平均基线最佳矫正视力（BCVA）为 0.25±0.26 对数最小角分辨率（logMAR）（0-1 logMAR）。治疗前 LSCD 分期为 1A 期 5 只眼（17.2%）、1B 期 12 只眼（41.4%）、1C 期 4 只眼（13.8%）、2A 期 4 只眼（13.8%）和 2B 期 4 只眼（13.8%）。6 只眼（20.7%）通过治疗原发性病因，完全缓解了 LSCD。其余眼在药物治疗后，LSCD 严重程度降至手术阈值以下，被认为是 2B 期。平均最终 BCVA 为 0.07±0.1 logMAR（0-0.4 logMAR）。
本研究表明，适当的治疗可以使 LSCD 完全或部分逆转，尤其是在基础角膜缘龛功能障碍中，炎症起重要作用。虽然角膜缘干细胞移植被认为是 LSCD 的主要治疗方法，但对于局限性和早期 LSCD，可以在不进行手术干预的情况下通过药物治疗有效管理。
