Ashton Christopher, Sibley Daniel, Balal Shafi, Ahmad Sajjad
External Diseases. Moorfield's Eye Hospital, London, United Kingdom .
Cornea. 2024 Nov 13;44(9):1151-1157. doi: 10.1097/ICO.0000000000003744.
To describe and report the outcomes of allogeneic eccentric superficial anterior lamellar keratoplasty (SALK), a novel surgical technique, in the management of total bilateral limbal stem cell deficiency (LSCD).
Data were collected retrospectively on all patients with total bilateral LSCD who underwent SALK. Previous surgery, preexisting glaucoma, conjunctivalization, vascularization, lens status, and preoperative best-corrected visual acuity (BCVA) were collected from medical notes.
Fifteen eyes underwent eccentric SALK between November 2018 and October 2021. The average age of patients at the time of SALK was 50.3 (SD ± 21.0). There were 4 male and 11 female patients, 9 left eyes and 6 right eyes. The mean difference between pre- and post-BCVA scores were 0.43 LogMAR (95% CI, 0.23-0.63). Ten patients noted an improvement in the features of LSCD with an improvement in BCVA. Five cases were deemed a complete success with a complete resolution of corneal epithelium, no recurrence of LSCD features and an improvement in BCVA. Patients who developed fungal keratitis had poor outcomes.
This study describes a new surgical technique of eccentric SALK to treat anterior stromal opacity and restore limbal stem cell function without systemic immunosuppression. The surgery improves the vision in most patients. However, in this complicated patient group, close postsurgical management is vital to recognize complications and intervene with treatment as needed.
描述并报告一种新型手术技术——同种异体偏心性浅层前板层角膜移植术（SALK）治疗双侧完全性角膜缘干细胞缺乏（LSCD）的效果。
回顾性收集所有接受SALK治疗的双侧完全性LSCD患者的数据。从病历中收集既往手术史、既往存在的青光眼、结膜化、血管化、晶状体状态以及术前最佳矫正视力（BCVA）。
2018年11月至2021年10月期间，15只眼接受了偏心性SALK手术。SALK手术时患者的平均年龄为50.3岁（标准差±21.0）。有4例男性和11例女性患者，9只左眼和6只右眼。BCVA评分术前和术后的平均差值为0.43 LogMAR（95%可信区间，0.23 - 0.63）。10例患者注意到LSCD特征有所改善，BCVA也有所提高。5例被认为完全成功，角膜上皮完全恢复，LSCD特征未复发，BCVA有所改善。发生真菌性角膜炎的患者预后较差。
本研究描述了一种新的手术技术——偏心性SALK，用于治疗前基质混浊并恢复角膜缘干细胞功能，且无需全身免疫抑制。该手术可改善大多数患者的视力。然而，在这个复杂的患者群体中，术后密切管理对于识别并发症并根据需要进行治疗干预至关重要。
