Kate Anahita, Rajagopal Raksheeth N, Sharma Supriya, Basu Sayan, Shanbhag Swapna S
Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Vijayawada, India.
Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.
Curr Eye Res. 2025 Jul;50(7):668-676. doi: 10.1080/02713683.2025.2482059. Epub 2025 Mar 27.
To identify the risk factors predictive of limbal stem cell deficiency (LSCD) in eyes with acute ocular burns (AOB).
This was a retrospective, comparative case series which included 112 eyes of 96 patients with AOB of severity > Dua grade II who had follow-up until complete epithelization. Data on injury details, clinical features, and treatment were collected. Logistic regression analysis was performed to identify risk factors for (i) LSCD following AOB, (ii) LSCD >6 clock hours, and (iii) LSCD requiring surgical intervention.
Of the 112 eyes, 61 eyes (54%) of 56 patients developed LSCD. The final median best-corrected visual acuity (BCVA) was poorer in eyes with LSCD [logMAR 0.9 (IQR: 0.5-1.5)] when compared to the non-LSCD group [logMAR 0.1 (IQR: 0-0.3); < .00001]. Regression analysis revealed lime injury (OR: 7.5, = .002), conjunctival defect of >50% area (OR = 7.6, = .0001), limbal epithelial defect of >6 clock hours (OR = 3.5, = .02), and undergoing repeat AMT (OR: 15.3, = .01) to be risk factors for the development of LSCD. For "LSCD of >6 clock hours", both conjunctival defect of >50% area [OR: 4.5 (CI: 1.2-16.9), = .03] and limbal epithelial defect of >6 clock hours [OR: 9.6 (CI: 1.9-48.6), = .006] were significant risk factors; while for the outcome "LSCD necessitating a surgical intervention", conjunctival defect of >50% area [OR: 4.1 (CI: 1.2-13.6), = .03] was a risk factor.
Patients with lime injury, limbal epithelial defects, and conjunctival epithelial defects involving a larger area are at a higher risk of development of LSCD post AOB. Larger conjunctival defects indicate the development of more severe LSCD and a greater need for surgical intervention. Eyes with LSCD have poorer visual outcomes. Thus, preventing this entity by addressing the risk factors can alleviate the socioeconomic burden on the affected individuals and the healthcare system.
确定急性眼烧伤（AOB）患者中预测角膜缘干细胞缺乏（LSCD）的危险因素。
这是一项回顾性、比较性病例系列研究，纳入了96例AOB严重程度>Dua二级且随访至上皮完全愈合的患者的112只眼。收集了损伤细节、临床特征和治疗的数据。进行逻辑回归分析以确定（i）AOB后发生LSCD、（ii）LSCD>6个钟点、（iii）需要手术干预的LSCD的危险因素。
在112只眼中，56例患者的61只眼（54%）发生了LSCD。与非LSCD组相比，发生LSCD的眼最终的最佳矫正视力（BCVA）中位数更差[logMAR 0.9（IQR：0.5 - 1.5）]，而非LSCD组为[logMAR 0.1（IQR：0 - 0.3）；P <.00001]。回归分析显示石灰烧伤（OR：7.5，P = 0.002）、结膜缺损面积>50%（OR = 7.6，P = 0.0001）、角膜缘上皮缺损>6个钟点（OR = 3.5，P = 0.02）以及接受重复羊膜移植（OR：15.3，P = 0.01）是发生LSCD的危险因素。对于“LSCD>6个钟点”，结膜缺损面积>50%[OR：4.5（CI：1.2 - 16.9），P = 0.03]和角膜缘上皮缺损>6个钟点[OR：9.6（CI：1.9 - 48.6），P = 0.006]均为显著危险因素；而对于“需要手术干预的LSCD”这一结果，结膜缺损面积>50%[OR：4.1（CI：1.2 - 13.6），P = 0.03]是危险因素。
发生石灰烧伤、角膜缘上皮缺损和结膜上皮缺损面积较大的患者在AOB后发生LSCD的风险较高。较大的结膜缺损表明更严重的LSCD的发生以及更大的手术干预需求。发生LSCD的眼视力预后较差。因此，通过解决危险因素来预防这种情况可以减轻对受影响个体和医疗系统的社会经济负担。
