目的:对有关经典格子角膜营养不良(LCD)的现有和理论治疗方式的最新文献进行简要总结和比较。本文旨在支持从业人员对这种疾病的管理。
方法:通过PubMed和GoogleScholar对截至2023年1月与LCD治疗有关的英语文章的现有文献进行了搜索。由于缺乏有关LCD的特定新疗法的文献,其他角膜病变的结果(颗粒状角膜营养不良,角膜疤痕)有时会包括在内以进行对比,这是明确表示。
结果:LCD是一种缓慢进展的疾病,可导致复发性角膜上皮糜烂,基质雾霾,角膜混浊,严重的不适,和视力障碍。由于其常染色体显性遗传模式,这种疾病可以在整个祖先系中持续存在,需要一致的治疗和随访。一个最佳的管理计划是必要的(1)延长寿命与最佳可实现的视力;(2)治疗疼痛性复发性角膜糜烂发生;(3)确保适当的随访在整个生命的患者,以及监测高危后代;(4)监测治疗效果。
结论:本文讨论了(1)早期疾病的治疗,包括角膜上皮清创,光治疗性角膜切除术(PTK),飞秒激光辅助板层角膜切削术(FLK),和其他;(2)治疗晚期疾病,包括全厚度角膜移植术和前板层角膜移植术;和(3)潜在的未来治疗考虑因素,包括各种局部/全身,遗传,和再生方法。
OBJECTIVE: To provide a brief summary and comparison of the most recent literature on available and theorized treatment modalities for classic lattice corneal dystrophy (LCD). This paper aims to support practitioners in their management of this disease.
METHODS: A search was carried out on available literature through PubMed and Google Scholar of English language articles up to January 2023 that relate to the treatment of LCD. Due to scarcity of literature regarding specific novel therapies for LCD, results from other corneal pathologies (granular corneal dystrophy, corneal scarring) are sometimes included for contrast, which is clearly denoted.
RESULTS: LCD is a slowly progressive disease that leads to recurrent epithelial corneal erosions, stromal haze, corneal opacification, substantial discomfort, and visual impairment. Due to its autosomal-dominant inheritance pattern, this disease can persist throughout ancestral lines and requires consistent treatment and follow-up. An optimal management plan is necessary to (1) prolong years of life with best achievable visual acuity; (2) treat painful recurrent corneal erosions as they occur; (3) ensure proper follow-up throughout the life of a patient, as well as monitor at-risk offspring; and (4) monitor efficacy of treatment.
CONCLUSIONS: This paper addresses (1) treatment for early disease including corneal epithelial debridement, photo therapeutic keratectomy (PTK), femtosecond laser-assisted lamellar keratectomy (FLK), and others; (2) treatment for late disease including full thickness keratoplasties and anterior lamellar keratoplasties; and (3) potential future treatment considerations including a wide variety of topical/systemic, genetic, and regenerative approaches.