■该案例描述了一种新颖的技术,该技术将微型结膜自体角膜缘移植物(CLAU)与深前板层角膜移植术(DALK)结合在一起,以防化学损伤后遗症。
方法:一名19岁女性,表现为角膜缘干细胞完全缺乏(LSCD)和左眼视轴血管化角膜瘢痕,化学损伤后4年。为了治疗LSCD并同时使患者在视觉上康复,进行了DALK的迷你CLAU。从右眼收获两个单独的一时钟CLAU并固定在左侧。在术后初期,移植物清晰,并在15个月的随访期内保持了清晰,巩膜隐形眼镜的视敏度为20/30。在同一时期,微型CLAU维持了稳定且上皮化良好的角膜表面。
■使用mini-CLAU代替传统的CLAU避免了供体眼中医源性LSCD的并发症,因为供体移植物的尺寸较小(1-2小时对6-8小时)。尽管尺寸较小,即使在完全LSCD的情况下,这些移植物也能有效维持良好上皮化的角膜表面.移植物的自体性质推迟了对免疫抑制的需要,并且当与角膜移植术结合时,其外周位置促进了手术技术的简易性。
结论:这种新颖的单阶段手术是一种有效的技术,可以重建稳定的眼表,并在视觉上恢复慢性化学损伤病例,具有良好的长期预后。
UNASSIGNED: This
case describes a novel technique combining a mini-conjunctival limbal autograft (CLAU) with a deep anterior lamellar keratoplasty (DALK) in a
case of chemical injury sequelae.
METHODS: A 19-year-old female presented with total limbal stem cell deficiency (LSCD) and a vascularized corneal scar in the visual axis of the left eye, 4 years following a chemical injury. In order to treat the LSCD and simultaneously visually rehabilitate the patient, a mini-CLAU with DALK was carried out. Two separate one clock-hour CLAUs were harvested from the right eye and secured in the left. The graft was clear in the initial postoperative period and maintained its clarity over 15 months of follow period with a visual acuity of 20/30 with scleral contact lenses. The mini-CLAUs sustained a stable and well epithelialized corneal surface during the same period.
UNASSIGNED: The use of the mini-CLAUs instead of the traditional CLAU circumvents the complication of an iatrogenic LSCD in the donor eye as the size of the donor grafts is smaller (1-2 clock hours versus 6-8 clock hours). Despite the smaller size, these grafts are efficacious in maintaining a well epithelialized corneal surface even in cases of total LSCD. The autologous nature of the graft defers the need for immunosuppression and its peripheral location facilitates ease of the surgical technique when combined with a keratoplasty.
CONCLUSIONS: This novel single-staged procedure is an effective technique to reestablish a stable ocular surface and to visually rehabilitate cases of chronic chemical injury with good long-term outcomes.