Ocular Surface最新文献_第5页

Target specification and therapeutic potential of extracellular vesicles for regulating corneal angiogenesis, lymphangiogenesis, and nerve repair 细胞外囊泡在调节角膜血管生成、淋巴管生成和神经修复方面的靶标定位和治疗潜力。

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.10.005

Cameron Pedersen , Victoria T. Chen , Paula Herbst , Runze Zhang , Amr Elfert , Abhi Krishan , Dimitri T. Azar , Jin-Hong Chang , Wen-Yang Hu , Tobias P. Kremsmayer , Elmira Jalilian , Ali R. Djalilian , Victor H. Guaiquil , Mark I. Rosenblatt

Extracellular vesicles, including exosomes, are small extracellular vesicles that range in size from 30 nm to 10 μm in diameter and have specific membrane markers. They are naturally secreted and are present in various bodily fluids, including blood, urine, and saliva, and through the variety of their internal cargo, they contribute to both normal physiological and pathological processes. These processes include immune modulation, neuronal synapse formation, cell differentiation, cancer metastasis, angiogenesis, lymphangiogenesis, progression of infectious disease, and neurodegenerative disorders like Alzheimer's and Parkinson's disease. In recent years, interest has grown in the use of exosomes as a potential drug delivery system for various diseases and injuries. Importantly, exosomes originating from a patient's own cells exhibit minimal immunogenicity and possess remarkable stability along with inherent and adjustable targeting capabilities. This review explores the roles of exosomes in angiogenesis, lymphangiogenesis, and nerve repair with a specific emphasis on these processes within the cornea. Furthermore, it examines exosomes derived from specific cell types, discusses the advantages of exosome-based therapies in modulating these processes, and presents some of the most established methods for exosome isolation. Exosome-based treatments are emerging as potential minimally invasive and non-immunogenic therapies that modulate corneal angiogenesis and lymphangiogenesis, as well as enhance and accelerate endogenous corneal nerve repair.

细胞外囊泡，包括外泌体，是一种小的细胞外囊泡，直径从 30 纳米到 10 微米不等，具有特定的膜标记。它们是自然分泌的，存在于血液、尿液和唾液等各种体液中，通过其内部货物的多样性，它们对正常的生理和病理过程都有贡献。这些过程包括免疫调节、神经元突触形成、细胞分化、癌症转移、血管生成、淋巴管生成、传染病进展以及阿尔茨海默氏症和帕金森氏症等神经退行性疾病。近年来，人们对外泌体作为一种潜在的药物输送系统用于治疗各种疾病和损伤的兴趣与日俱增。重要的是，源于患者自身细胞的外泌体具有极低的免疫原性、出色的稳定性以及固有的可调节靶向能力。本综述探讨了外泌体在血管生成、淋巴管生成和神经修复中的作用，并特别强调了角膜中的这些过程。此外，它还研究了从特定细胞类型中提取的外泌体，讨论了基于外泌体的疗法在调节这些过程中的优势，并介绍了一些最成熟的外泌体分离方法。基于外泌体的疗法正在成为潜在的微创、非免疫原性疗法，可调节角膜血管生成和淋巴管生成，并增强和加速内源性角膜神经修复。

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引用次数: 0

Simple limbal epithelial transplantation versus cultivated limbal epithelial transplantation in ocular burns 眼烧伤中的单纯角膜缘上皮移植与角膜缘上皮培养移植。

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.10.007

Namrata Sharma , Renu Venugopal , Sujata Mohanty , K. Priyadarshini , Ritu Nagpal , Deepali Singhal , Aafreen Bari , Tanuj Dada , Prafulla Kumar Maharana , Tushar Agarwal , Ashish Dutt Upadhyay

Purpose

To compare the outcomes of simple limbal epithelial transplantation (SLET) with cultivated limbal epithelial transplantation (CLET) for the management of total limbal stem cell deficiency (LSCD) in eyes with unilateral ocular burns.

Design

Randomized controlled trial.

Methods

100 patients (100 eyes) with unilateral total LSCD following ocular burns undergoing autologous Limbal Stem Cell Transplantation (LSCT) were enrolled and randomized into SLET and CLET groups. Restoration of an epithelized ocular surface was the primary outcome measure. Occurrences of progressive conjunctivalization and persistent epithelial defects postoperatively were considered surgical failures.

Results

Mean age was 20.2 ± 13.1 years (SLET) and 22.6 ± 14.3 years (CLET) (p = 0.363). Alkali burn was the most common causative factor in both groups and had comparable mean logMAR BCVA at presentation [SLET: 2.33 ± 0.5, CLET: 2.23 ± 1.48 (p = 0.652)]. Median time interval between injury and surgical intervention was 18 months (SLET) and 12 months (CLET) (p = 0.06). 88 % eyes in SLET group maintained a stable ocular surface at 1 year period versus CLET group (86 %) (p = 0.999). Mean logMAR BCVA significantly improved in both groups with SLET having significantly better BCVA versus CLET at 6 months (p = 0.0390), 1 year (p = 0.0001), 2 year (p = 0.0001) and 3 years (p = 0.0001) follow up. Kaplan-Meier survival analysis was statistically insignificant amongst the 2 groups (p = 0.590).

Conclusions

Compared to CLET, SLET is equally efficacious in restoring and maintaining a stable ocular surface in eyes with total LSCD due to ocular burns, with the added advantage of providing superior visual outcomes.

目的：比较单纯瓣上皮移植术（SLET）和培养瓣上皮移植术（CLET）治疗单侧眼烧伤后全瓣干细胞缺乏症（LSCD）的疗效：随机对照试验。方法：100 名眼部烧伤后单侧全缘干细胞缺乏症患者（100 只眼）接受自体眼缘干细胞移植术（LSCT），并随机分为 SLET 组和 CLET 组。恢复上皮化的眼表是衡量疗效的主要指标。术后出现进行性结膜化和持续性上皮缺损被视为手术失败：平均年龄为 20.2 ± 13.1 岁（SLET）和 22.6 ± 14.3 岁（CLET）（p = 0.363）。碱烧伤是两组患者最常见的致病因素，两组患者发病时的 BCVA 平均对数值相当[SLET：2.33 ± 0.5，CLET：2.23 ± 1.48 (p = 0.652)]。从受伤到手术干预的中位时间间隔为 18 个月（SLET）和 12 个月（CLET）（p = 0.06）。SLET组88%的眼睛在1年后眼表保持稳定，而CLET组为86%（p = 0.999）。两组患者的 BCVA 平均对数均有显著改善，SLET 组在 6 个月（p = 0.0390）、1 年（p = 0.0001）、2 年（p = 0.0001）和 3 年（p = 0.0001）随访期间的 BCVA 均明显优于 CLET 组。Kaplan-Meier生存率分析结果显示，两组间差异无统计学意义（p = 0.590）：结论：与 CLET 相比，SLET 在恢复和维持因眼部烧伤导致的全 LSCD 眼的眼表稳定方面同样有效，而且还具有视觉效果更佳的优势。

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引用次数: 0

Readership awareness series – paper 14: The submission Dilemma - How to choose a journal? 读者意识丛书--论文 14：投稿困境--如何选择期刊？

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.11.003

Mohammad Javed Ali, Ali Djalilian

引用次数: 0

Cytarabine chemotherapy induces meibomian gland dysfunction 阿糖胞苷化疗诱发睑板腺功能障碍

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.10.002

Ren Liu , Jianwen Xue , Jiaxu Han, Mengqian Tu, Wenhui Wang, Ziyan Chen, Xiaobing Qian, Bing Xiao, Lingyi Liang

Purpose

Cytarabine (Ara-C) chemotherapy causes symptoms resembling meibomian gland dysfunction (MGD), suggesting potential associations between Ara-C and MGD. In this study, the pathological effects of Ara-C on MGD were investigated in a rodent model.

Methods

Mice received Ara-C with or without rosiglitazone (PPARγ agonist) for 7 consecutive days. Slit-lamp biomicroscope was used for ocular examinations. Immunofluorescence detected acinar cell proliferation, differentiation, and ductal keratinization in the meibomian gland (MG). Lipid accumulation was evaluated by Oil Red O and LipidTox staining. Lipogenic status, FoxO1/FoxO3a cellular localization, and oxidative stress were visualized via immunohistochemistry. Western blotting assessed relative protein expression and AKT/FoxO1/FoxO3a pathway phosphorylation.

Results

Ara-C (50 mg/kg) did not affect mouse survival but induced damage to ocular surface microenvironment, including corneal epithelial defects, MG orifice plugging and acinar dropout, and lacrimal gland (LG) dysfunction. Ara-C intervention inhibited proliferation and caused progenitor loss in the MG, as evidenced by reduced PCNA + labeling and P63+/Lrig1+ basal cell numbers. The MG ducts of Ara-C-treated mice exhibited marked dilatation, lipid deposition, and hyperkeratinization (K1/K10 overexpression). Ara-C disrupted MG lipid metabolism by downregulating PPARγ and its downstream lipogenic targets AWAT2/SOAT1/ELOVL4 and upregulating HMGCR. Dephosphorylation of AKT and the subsequent nuclear translocation of FoxO1/FoxO3a contributed to Ara-C-induced PPARγ downregulation. Ara-C triggered oxidative stress with increases in 4-HNE and 8-OHdG and Keap1/Nrf2/HO-1/SOD1 axis dysregulation. Rosiglitazone treatment ameliorated MGD-associated pathological manifestations, LG function, MG lipid metabolism, and oxidative stress in Ara-C-exposed mice.

Conclusions

Systemic Ara-C chemotherapy exerted topical cytotoxic effects on the ocular surface, and PPARγ restoration by rosiglitazone mitigated Ara-C-induced MGD alterations.

目的阿糖胞苷（Ara-C）化疗会导致类似睑板腺功能障碍（MGD）的症状，这表明 Ara-C 和 MGD 之间可能存在关联。本研究在啮齿动物模型中研究了 Ara-C 对 MGD 的病理影响。使用裂隙灯生物显微镜进行眼部检查。免疫荧光检测睑板腺（MG）中的尖状细胞增殖、分化和导管角化。油红 O 和脂毒染色法评估了脂质积累情况。通过免疫组化观察生脂状态、FoxO1/FoxO3a细胞定位和氧化应激。结果 Ara-C（50 毫克/千克）不影响小鼠的存活率，但会导致眼表微环境受损，包括角膜上皮缺损、MG 口堵塞和尖锐湿疣脱落以及泪腺（LG）功能障碍。Ara-C干预抑制了MG的增殖并导致祖细胞丢失，PCNA+标记和P63+/Lrig1+基底细胞数量的减少证明了这一点。经 Ara-C 处理的小鼠的 MG 管表现出明显的扩张、脂质沉积和过度角质化（K1/K10 过度表达）。Ara-C 通过下调 PPARγ 及其下游致脂靶标 AWAT2/SOAT1/ELOVL4 和上调 HMGCR 破坏了 MG 的脂质代谢。AKT 的去磷酸化和随后 FoxO1/FoxO3a 的核转位有助于 Ara-C 诱导的 PPARγ 下调。Ara-C 引发氧化应激，导致 4-HNE 和 8-OHdG 增加，Keap1/Nrf2/HO-1/SOD1 轴失调。结论系统性 Ara-C 化疗对眼表产生局部细胞毒性作用，罗格列酮对 PPARγ 的恢复减轻了 Ara-C 诱导的 MGD 改变。

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引用次数: 0

Blinded by smoke: Wildfire smoke exposure and eye irritation in australian wildland firefighters 烟雾致盲：澳大利亚野地消防员的野火烟雾暴露和眼部刺激。

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.09.001

Sukanya Jaiswal , Isabelle Jalbert , Nicholas Olsen , Anthea Burnett , Blanka Golebiowski

Purpose

Wildfire occurrence is increasing worldwide, putting firefighters and general public at increased risk of eye injuries from smoke exposure. This study explored ocular symptoms and use of protective eyewear amongst wildland firefighters in Australia.

Methods

Australian wildland firefighters were invited to complete an online survey about the occurrence of eye irritation, use of protective eyewear and behaviours associated with occupational smoke exposure. Responses were analysed using logistic regression and qualitative inductive content analysis.

Results

338 wildland firefighters completed the survey. Eye irritation was reported by 90 % of firefighters at least sometimes during work and by 70 % after work. Frequency of eye irritation was greater amongst females than males (OR 2.01, CI 1.22–3.31, p < 0.001). Protective eyewear was used often or always by 67 % of firefighters on the fireground, however 55 % had to remove their protective eyewear due to sweat, fogging or another reason. Goggles were more likely to be removed compared to sunglasses and safety glasses (OR 4.28, CI 2.75–6.68, p < 0.001).

Firefighters reported that, at times smoke exposure necessitated eye closure and impaired vision on the fireground. Firefighters also reported that protective eyewear helped to reduce eye symptoms, but its consistent use on the fireground was difficult. The severity and recovery from eye symptoms varied between participants.

Conclusion

Australian wildland firefighters frequently experience eye irritation from smoke exposure, and this can affect operational capabilities. These findings can support the development of evidence-based strategies to help protect and aid recovery of the eye surface following smoke exposure.

目的：世界各地发生的野火越来越多，消防员和普通公众因暴露在烟雾中而受到眼睛伤害的风险也越来越大。本研究探讨了澳大利亚野外消防员的眼部症状和防护眼镜的使用情况：方法：邀请澳大利亚野外消防员完成一项在线调查，内容涉及眼部刺激的发生、防护眼镜的使用以及与职业烟雾暴露相关的行为。采用逻辑回归和定性归纳内容分析法对回答进行了分析：结果：338 名野外消防员完成了调查。90%的消防员表示至少有时在工作期间和 70% 的消防员在下班后眼睛受到刺激。女性受到眼睛刺激的频率高于男性（OR 2.01，CI 1.22 - 3.31，p）：澳大利亚野地消防员经常会因暴露于烟雾中而感到眼睛不适，这可能会影响他们的工作能力。这些发现有助于制定以证据为基础的策略，以帮助保护和帮助烟雾暴露后的眼表恢复。

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引用次数: 0

Adipose-derived mesenchymal stromal cells: A study on safety and efficacy in ocular inflammation 脂肪间充质基质细胞：眼部炎症的安全性和有效性研究。

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.11.001

Robert M. Rusch , Emi Inagaki , Hiroko Taniguchi , Saki Sakakura , Rie Tamai , Hidenori Nonaka , Shota Shimizu , Shinri Sato , Yoko Ogawa , Hirayama Masatoshi , Kazuno Negishi , Hideyuki Okano , Shigeto Shimmura

Purpose

This study explores the application of adipose-derived mesenchymal stromal cells (adMSCs) as a therapy for ocular inflammatory diseases utilizing a chronic GVHD model.

Methods

Human adMSCs were administered via subconjunctival injection into mice with chronic ocular GVHD. Clinical scores and changes in T cell populations were analyzed.

Results

The study showed significant improvement in corneal integrity, including epithelial damage, opacity, thickness, and structure, after subconjunctival adMSC transplantation. Additionally, adMSC transplantation increased CD45⁺ and Foxp3⁺ Tregs while decreasing CD4⁺ T cells, 1IL17A⁺ Th17 cells, and IFNγ⁺ Th1 cells in local cervical lymph nodes. Moreover, adMSC-conditioned media enhanced wound closure and cell migration toward the wound bed in vitro. The cells disappeared within a week suggesting that trophic factors were involved.

Conclusion

The dual benefit of adMSCs in immune-related ocular disorders underscores their potential for clinical application. This study focuses on subconjunctival delivery, effects of adMSCs and migration post-injection, with implications for optimizing cellular therapy application. The observed dual action, combining immunomodulation and tissue repair enhancement, underscores holistic approach of adMSC therapy in regenerative medicine, making it a potent treatment for diseases involving inflammation and tissue damage in the ocular surface.

目的：本研究探讨了脂肪间充质基质细胞（adMSCs）作为眼部炎症性疾病疗法的应用，并利用了慢性GVHD模型。分析临床评分和 T 细胞群的变化：研究结果表明，结膜下移植 adMSC 后，角膜完整性（包括上皮损伤、不透明、厚度和结构）明显改善。此外，adMSC移植增加了CD45+和Foxp3+ Tregs，同时减少了局部颈淋巴结中的CD4+ T细胞、1IL17A+ Th17细胞和IFNγ+ Th1细胞。此外，经 adMSC 培养基调节的细胞在体外可增强伤口闭合和细胞向伤口床的迁移。这些细胞在一周内消失，表明营养因子参与其中：adMSCs 对免疫相关眼部疾病的双重益处凸显了其临床应用的潜力。这项研究的重点是结膜下递送、adMSCs 的作用以及注射后的迁移，这对优化细胞疗法的应用具有重要意义。所观察到的免疫调节和组织修复增强的双重作用强调了 adMSC 疗法在再生医学中的整体性，使其成为治疗眼表炎症和组织损伤疾病的有效方法。

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引用次数: 0

When noise becomes signal: A study of blink rate using an eye tracker 当噪音变成信号：使用眼球跟踪器对眨眼率的研究。

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.11.002

Krishnaveni Nagarajan , Kavya Ravi , Shakthi Pradheepa Periakaruppan , PremNandhini Satgunam

Purpose

Although blink rate is considered important for digital eye strain and dry eye conditions, its assessment has been mostly manual. This study aimed at quantifying blink rate automatically using the Eyelink 1000 Plus eye tracker and comparing it with manual counting. Additionally, blink rate was correlated with reading eye movements and reading speed.

Methods

Thirty participants (mean age 26.8 ± 3.5 years; 19 females) were enrolled. An on-screen reading task for 3 min duration, was repeated 3 times with a 2-min break between the repetitions. During this task, eye movements and blinks were measured through the Eyelink 1000 Plus eye tracker. The blink was also counted manually by the examiner in real time from a video feed.

Results

The blink rate obtained by the eye tracker (median [Q1, Q3]:11.7 [6.8,15.5] blinks/min) and manual counting (11.6 [7.1, 15.4] blinks/min) were comparable (p > 0.5). No significant correlations were observed between the blink rate and any of the reading eye movement parameters except saccadic amplitude (Spearman's rho, r_s = 0.506). No statistically significant correlation was found between the blink rate and reading speed.

Conclusion

The Eyelink 1000 Plus eye tracker gives a comparable blink rate compared to that obtained through manual counting. A positive correlation between the blink rate and saccade amplitude could indicate a coupled interaction between the two mechanisms to minimize visual loss during reading. The option of using this tracker to investigate blinks in dry eye and binocular vision disorders can be further explored.

目的：虽然眨眼率被认为对数码眼疲劳和干眼症很重要，但其评估大多采用人工方式。本研究旨在使用 Eyelink 1000 Plus 眼动仪自动量化眨眼率，并与人工计数进行比较。此外，眨眼率还与阅读时的眼球运动和阅读速度相关：方法：共招募了 30 名参与者（平均年龄为 26.8±3.5 岁；19 名女性）。屏幕阅读任务持续 3 分钟，重复 3 次，每次之间休息 2 分钟。任务期间，通过 Eyelink 1000 Plus 眼动仪测量眼球运动和眨眼情况。眨眼次数也由检查员通过视频实时手动计数：结果：眼球跟踪仪（中位数[Q1, Q3]：11.7 [6.8, 15.5]次/分钟）和人工计数（11.6 [7.1, 15.4]次/分钟）得出的眨眼率相当（P>0.5）。眨眼次数与任何阅读眼动参数之间都没有明显的相关性，但眼球回转幅度除外（Spearman's rho，rs =0.506）。眨眼次数与阅读速度之间没有统计学意义上的相关性：结论：Eyelink 1000 Plus 眼动仪的眨眼率与人工计数的眨眼率相当。眨眼率与囊状移动幅度之间的正相关可能表明这两种机制之间存在耦合互动，从而最大限度地减少阅读过程中的视觉损失。还可以进一步探索使用这种跟踪器来研究干眼症和双眼视力障碍患者的眨眼情况。

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引用次数: 0

Big-bubble DALK: A technique in evolution 大气泡 DALK：进化中的一种技术。

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.10.001

Antonio Moramarco , Lorenzo Gardini , Ilaria Di Mola , Natalie di Geronimo , Danilo Iannetta , Vito Romano , Sadeer B. Hannush , Luigi Fontana

Deep anterior lamellar keratoplasty (DALK) is considered a valuablealternative to penetrating keratoplasty (PK) for treatingcorneal disordersthat do not involve theendothelium. DALK preserves the host endothelium, eliminating the risk of endothelial rejection and reducing the risk of late graft failure due to endothelial decay. Despite its not recent introduction, DALK has been considered a difficult, lengthy, and poorly reproducible procedure, limiting its adoption worldwide. With the introduction of the big-bubble technique (BBT) the reproducibility and the time required to complete the procedure were significantly improved, encouraging many surgeons to approach DALK. With BBT air is injected into the stroma to induce separation between the layers of the cornea, facilitating the separation of the diseased or scarred stroma from the healthy endothelium; this allows the creation of a graft-host interface of pristine optical quality, granting clinical results equal to those obtained with PK.Understanding the anatomy and physics behind the big bubble (BB) formation is crucial for thesurgical success of this technique. The discovery of the pre-Descemet's layer (Dua's layer)played a significant role in understanding the principles behindBBformation, considerablyimpacting the safety and reproducibility of the technique. BB formation is influenced by preoperative pathology, trephination size, and instruments used for air injection.Continue advancements have helped to refine BBT's efficacy and reproducibility, broadening its applicability in corneal transplantation whenever the endothelium is healthy.This review provides a detailed account of the procedural steps involved in DALK using the BBT, addressing the most common challenges, highlightingtechnical innovations, and handlingthe most frequent complications.

深前片状角膜移植术（DALK）被认为是穿透性角膜移植术（PK）的一种重要替代方法，可用于治疗不涉及内皮的角膜疾病。DALK 保留了宿主内皮，消除了内皮排斥的风险，并降低了因内皮衰变而导致后期移植物失败的风险。尽管 DALK 术问世时间不长，但一直被认为是一种难度大、时间长、可重复性差的手术，这限制了它在全球范围内的应用。随着大气泡技术（BBT）的引入，可重复性和完成手术所需的时间都得到了显著改善，鼓励了许多外科医生采用 DALK。大气泡技术将空气注入角膜基质层，诱导角膜层间分离，促进病变或瘢痕角膜基质层与健康角膜内皮层的分离；这样就能创造出具有原始光学质量的移植物-宿主界面，获得与 PK 技术相同的临床效果。前戴斯麦层（Dua层）的发现对了解大泡形成背后的原理起到了重要作用，极大地影响了该技术的安全性和可重复性。BBT的形成受术前病理、切削大小和注入空气所用器械的影响。不断的进步帮助完善了BBT的疗效和可重复性，扩大了其在角膜移植中的适用范围，只要角膜内皮是健康的。本综述详细介绍了使用BBT进行DALK的手术步骤，解决了最常见的难题，突出了技术创新，并处理了最常见的并发症。

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引用次数: 0

Meibomian gland tortuosity, truncation, and dilation in paediatric dry eye disease: A multi-centre, investigator-masked, cross-sectional study 研究通讯标题：小儿干眼症中的睑板腺迂曲、截断和扩张：一项多中心、研究者掩蔽的横断面研究

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.09.009

Michael T.M. Wang, James S. Wolffsohn, Ji Soo Kim, Sophie Speakman, Edward Pritchard, Barry Power, Jennifer P. Craig

引用次数: 0

“En bloc” combined 270-degree keratolimbal allograft with central lamellar keratoplasty for severe limbal stem cell deficiency secondary to mustard gas exposure "整体 "联合 270 度角膜同种异体移植术和中央板层角膜移植术，用于治疗芥子气暴露导致的严重角膜干细胞缺乏症。

IF 5.9 1区医学 Q1 OPHTHALMOLOGY

Ocular Surface

Pub Date : 2024-10-01 DOI: 10.1016/j.jtos.2024.10.006

Farid Karimian , Kiana Hassanpour , Mohammadreza Arzaghi , Zahra Karjou

Background

Severe limbal stem cell deficiency (LSCD) resulting from chronic and delayed-onset mustard gas keratopathy (MGK) presents substantial management challenges. This article introduces an “en bloc” surgical procedure combining a 270-degree keratolimbal allograft (KLAL) with central lamellar keratoplasty (CLK) as a novel approach to treat this condition.

Methods

A retrospective case series was conducted at Labbafinejad Medical Center in Tehran, Iran, from 2002 to 2019, including 13 eyes from 13 male patients diagnosed with chronic and delayed-onset MGK. Each patient underwent the combined 270-degree KLAL and central LK procedure. A 270-degree peritomy, sparing the superior quadrant, was performed. A lamellar dissection using a crescent blade and a blunt Melles dissector was carried out, extending 2 mm from the limbus. Fresh donor tissue with intact 270-degree limbo-conjunctiva, obtained from a whole globe, was prepared to match the recipient bed and sutured into place. Postoperative outcomes and success including ocular surface integrity, graft longevity, and best-corrected visual acuity (BCVA), were evaluated.

Results

The average follow-up period was 87.6 ± 49.8 months. Surgical success was achieved in 12 of 13 patients (92.3 %). Preoperative BCVA improved from 1.07 ± 0.24 (approximately 20/250) logMAR to 0.63 ± 0.30 (approximately 20/80) logMAR postoperatively. One patient experienced immune rejection of the KLAL graft, while two patients had episodes of corneal rejection, all successfully managed with aggressive immunosuppressive therapy.

Conclusions

The “en bloc KLAL + CLK” procedure demonstrates promising long-term outcomes in managing chronic and delayed-onset MGK associated with severe LSCD. This approach offers advantages, including reduced surgical complexity, minimized antigenic load, and better anatomical alignment, leading to successful ocular surface restoration and improved visual acuity.

背景：慢性和迟发性芥子气角膜病（MGK）导致的严重角膜缘干细胞缺乏症（LSCD）给治疗带来了巨大挑战。本文介绍了一种结合270度角膜同种异体移植术（KLAL）和中央板层角膜移植术（CLK）的 "整体 "手术方法，作为治疗这种疾病的新方法：2002年至2019年，伊朗德黑兰拉巴菲内贾德医疗中心开展了一项回顾性病例系列研究，其中包括13名被诊断为慢性和迟发性MGK的男性患者的13只眼睛。每位患者都接受了 270 度 KLAL 和中央 LK 联合手术。手术进行了 270 度周边切除术，并保留了上象限。使用新月形刀片和钝性梅勒斯剥离器进行板层剥离，剥离范围为距角膜缘 2 毫米处。从一个完整的球体上获取带有完整的270度边缘结膜的新鲜供体组织，准备好与受体床相匹配的组织并缝合到位。对术后效果和成功率进行了评估，包括眼表完整性、移植物寿命和最佳矫正视力（BCVA）：平均随访时间为 87.6 ± 49.8 个月。13 位患者中有 12 位（92.3%）手术成功。术前 BCVA 从 1.07 ± 0.24（约 20/250）logMAR 提高到术后的 0.63 ± 0.30（约 20/80）logMAR。一名患者出现了 KLAL 移植免疫排斥反应，两名患者出现了角膜排斥反应，但都通过积极的免疫抑制治疗得到了成功控制：结论："en bloc KLAL + CLK "手术在治疗与重度LSCD相关的慢性和迟发性MGK方面具有良好的长期疗效。这种方法的优势包括降低手术复杂性、最大限度地减少抗原负荷以及更好的解剖对位，从而成功恢复眼表并提高视力。

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引用次数: 0