巩膜镜控制干眼症(英文)VIP免费

UseofFluid-Ventilated,Gas-PermeableScleralLensforManagementofSevereKeratoconjunctivitisSiccaSecondarytoChronicGraft-versus-HostDiseaseKikuchiTakahide,1PabloM.Parker,2MichaelWu,3WilliamY.K.Hwang,4PaulA.Carpenter,1,3CarinaMoravec,1BarbaraStehr,2PaulJ.Martin,1,3PerryRosenthal,5StephenJ.Forman,2MaryE.D.Flowers1,31FredHutchinsonCancerResearchCenter,2HematologyandHematopoieticCellTransplantation,CityofHopeNationalMedicalCenter,3UniversityofWashington,Seattle,Washington;4SingaporeGeneralHospital,SingHealth,Singapore;and5HarvardMedicalSchoolandBostonFoundationforSight,Boston,MassachusettsCorrespondenceandreprintrequests:MaryE.D.Flowers,MD,ClinicalResearchDivision,FredHutchinsonCancerResearchCenter,1100FairviewAvenueN,D5-290,Seattle,WA98109(e-mail:mflowers@fhcrc.org).ReceivedMarch21,2007;acceptedMay7,2007ABSTRACTKeratoconjunctivitissicca(KCS)occursin40%-60%ofpatientswithchronicgraft-versus-host-disease(cGVHD)afterallogeneichematopoieticcelltransplantation.AlthoughimmunosuppressivetherapyistheprimarytreatmentofchronicGVHD,ocularsymptomsrequiremeasurestoimproveocularlubrication,decreaseinflammation,andmaintainmucosalintegrity.Theliquidcornealbandageprovidedbyafluid-ventilated,gas-permeablesclerallens(SL)hasbeeneffectiveinmitigatingsymptomsandresurfacingcornealerosionsinpatientswithKCSrelatedtocausesotherthancGVHD.Wereportoutcomesin9consecutivepatientsreferredforSLfittingforcGVHD-relatedsevereKCSthatwasrefractorytostandardtreatments.AllpatientsreportedimprovementofocularsymptomsandreducedtheuseoftopicallubricantsafterSLfittingresultingfromdecreasedevaporation.NoseriousadverseeventsorinfectionsattributabletotheSLoccurred.ThemedianOcularSurfaceDiseaseIndeximprovedfrom81(75-100)to21(6-52)within2weeksafterSLfitting,andwas12(2-53)atthetimeoflastcontact,1-23months(median,8.0)afterSLfitting.DisabilityrelatedtoKCSresolvedin7patientsafterSLfitting.TheuseofSLappearstobesafeandeffectiveinpatientswithseverecGVHD-relatedKCSrefractorytoconventionaltherapies.©2007AmericanSocietyforBloodandMarrowTransplantationKEYWORDSGraft-versus-hostdisease●Keratoconjunctivitissicca●AllogeneichematopoieticcelltransplantationINTRODUCTIONThetermkeratoconjunctivitissicca(KCS)denotesinflammationcausedbydrynessoftheconjunctivaandcornea.Ocularchronicgraft-versus-hostdisease(cGVHD)cancauseacuteconjunctivalinflammation,pseudomembranousandcicatricialconjunctivitis,andKCS.DryeyesorKCSoccursinapproximately40%-60%ofpatientswithcGVHDafterallogeneichema-topoieticcelltransplantation(HCT)[1-3]andmayrepresenttheonly,ormostsignificant,clinicalman-ifestationandsequelaeofcGVHDinsomepatients.PatientswithKCSmaydevelopcornealerosionsandfilamentscausingseverepainandphotophobia.Ifinadequatelymanaged,cornealepitheliopathycanprogresstopersistentepithelialdefects,sterilecor-nealulcers,secondaryinfectiouskeratitis,andcor-nealperforation,leadingtostromalscarringandlossofvision[4].Systemicimmunosuppressivetherapymaybeneededtohaltinflammatoryprocesses,andissome-timesindicatedwhencGVHDoftheeyeisresistanttolocaltherapyorassociatedwithotherorganinvolve-ment[5].cGVHDcancauseirreversibledamagetosebumandtear-producingcells,withsequelaeresult-inginconsiderabledisability.Forthesepatients,an-cillaryandsupportivecarefortheeyeisdirectedtoimprovingocularsurfacelubricationanddecreasinginflammation.Suchtreatmentsincludeartificialtears,BiologyofBloodandMa...