AIM:To evaluate chronic ocular sequelae in patients with symblepharon caused by ocular burns and propose an objective grading system.METHODS:This was a retrospective,single-center clinical study.Patients with symbleph...AIM:To evaluate chronic ocular sequelae in patients with symblepharon caused by ocular burns and propose an objective grading system.METHODS:This was a retrospective,single-center clinical study.Patients with symblepharon caused by ocular burns at least six months later were assessed.Chronic ocular sequelae were classified into 3 categories(eyelid,conjunctiva,and cornea)and 9 chronic ocular sequelae[friction factors,exposure factors,conjunctival hyperemia,length of symblepharon,scope of adhesion,lacrimal area adhesion,loss of the palisades of Vogt(POV),corneal neovascularization,and corneal opacification].Each ocular sequela was graded from 0 to 3,depending on the increasing severity.The 9 ocular sequelae were evaluated to obtain the total severity score for each eye.The total severity score was defined as Grade I(1-9),Grade II(10-18),and Grade III(19-27).Moreover,the correlation between the severity of chronic ocular sequelae and visual acuity,surgical strategy,and the prognosis was analyzed,respectively.RESULTS:Cases of 79 eyes with symblepharon caused by ocular burns were included in this study.Of these,20(25.32%)were defined as Grade I,43(54.43%)as Grade II,and 16(20.25%)as Grade III.Eyes with a high total severity score had reduced visual acuity,required complicated surger y strategies,and poor prognosis(P<0.001).Multivariate regression analysis showed that the scope of adhesion,corneal opacification,and corneal neovascularization significantly affected visual acuity,surgical strategy,and prognosis(all P<0.001).CONCLUSION:The evaluation of chronic ocular sequelae enabled the development of an objective grading system for patients with symblepharon caused by ocular burns.This grading system can be applied to guide the treatment and predict the prognosis.展开更多
Ocular cicatricial pemphigoid(OCP)is a subcategory of mucous membrane pemphigoid(MMP)where the conjunctiva is the main site of inflammation.It is a chronic and autoimmune disease characterized by acute and chronic con...Ocular cicatricial pemphigoid(OCP)is a subcategory of mucous membrane pemphigoid(MMP)where the conjunctiva is the main site of inflammation.It is a chronic and autoimmune disease characterized by acute and chronic conjunctivitis that can progress to severe conjunctival cicatrization,corneal opacification,ocular surface keratinization,and eyelid abnormalities.OCP can lead to structural damage that can result in visual impairment,visual loss,and blindness,and can have a significant impact in a patient’s quality of life.Patients may manifest with varying symptoms,degrees of severity and may have different rates of progression.Early diagnosis and appropriate systemic immunosuppression are of utmost importance for prompt and adequate disease control.Various systemic immunomodulatory therapies(IMTs),including anti-metabolites,alkylating,and biologic agents have been utilized to achieve inflammation control and remission.Careful monitoring of disease progression is important to assess response and to modify and escalate therapy if needed.Treatment to alleviate symptoms of dry eye disease and address trichiasis and other eyelid abnormalities is recommended as well.A multidisciplinary approach to optimize clinical care is recommended in the management of patients with OCP.This review will address the immunopathogenesis,clinical features,keys to diagnosis and staging of patients with OCP.It will highlight the current immunomodulators utilized for disease management and proposed stepladder strategies.This review will discuss the updated roles of combination therapy,novel use of biologics as well as the recent use of adrenocorticotropic hormone(ACTH)analog in severe recalcitrant cases.展开更多
基金Supported by the National Natural Science Foundation of China(No.81770888)the Shanghai Municipal Education Commission Gaofeng Clinical Medicine Grant Support(No.20161421)+2 种基金the Shanghai Municipal Science and Technology Commission the Commercialization and Industrialization of Research Findings Project(No.17411963800)Shanghai Pujiang Program(No.18PJD025)Shanghai Jiao Tong University School of Medicine Two-hundred Talent(No.20191914)。
文摘AIM:To evaluate chronic ocular sequelae in patients with symblepharon caused by ocular burns and propose an objective grading system.METHODS:This was a retrospective,single-center clinical study.Patients with symblepharon caused by ocular burns at least six months later were assessed.Chronic ocular sequelae were classified into 3 categories(eyelid,conjunctiva,and cornea)and 9 chronic ocular sequelae[friction factors,exposure factors,conjunctival hyperemia,length of symblepharon,scope of adhesion,lacrimal area adhesion,loss of the palisades of Vogt(POV),corneal neovascularization,and corneal opacification].Each ocular sequela was graded from 0 to 3,depending on the increasing severity.The 9 ocular sequelae were evaluated to obtain the total severity score for each eye.The total severity score was defined as Grade I(1-9),Grade II(10-18),and Grade III(19-27).Moreover,the correlation between the severity of chronic ocular sequelae and visual acuity,surgical strategy,and the prognosis was analyzed,respectively.RESULTS:Cases of 79 eyes with symblepharon caused by ocular burns were included in this study.Of these,20(25.32%)were defined as Grade I,43(54.43%)as Grade II,and 16(20.25%)as Grade III.Eyes with a high total severity score had reduced visual acuity,required complicated surger y strategies,and poor prognosis(P<0.001).Multivariate regression analysis showed that the scope of adhesion,corneal opacification,and corneal neovascularization significantly affected visual acuity,surgical strategy,and prognosis(all P<0.001).CONCLUSION:The evaluation of chronic ocular sequelae enabled the development of an objective grading system for patients with symblepharon caused by ocular burns.This grading system can be applied to guide the treatment and predict the prognosis.
文摘Ocular cicatricial pemphigoid(OCP)is a subcategory of mucous membrane pemphigoid(MMP)where the conjunctiva is the main site of inflammation.It is a chronic and autoimmune disease characterized by acute and chronic conjunctivitis that can progress to severe conjunctival cicatrization,corneal opacification,ocular surface keratinization,and eyelid abnormalities.OCP can lead to structural damage that can result in visual impairment,visual loss,and blindness,and can have a significant impact in a patient’s quality of life.Patients may manifest with varying symptoms,degrees of severity and may have different rates of progression.Early diagnosis and appropriate systemic immunosuppression are of utmost importance for prompt and adequate disease control.Various systemic immunomodulatory therapies(IMTs),including anti-metabolites,alkylating,and biologic agents have been utilized to achieve inflammation control and remission.Careful monitoring of disease progression is important to assess response and to modify and escalate therapy if needed.Treatment to alleviate symptoms of dry eye disease and address trichiasis and other eyelid abnormalities is recommended as well.A multidisciplinary approach to optimize clinical care is recommended in the management of patients with OCP.This review will address the immunopathogenesis,clinical features,keys to diagnosis and staging of patients with OCP.It will highlight the current immunomodulators utilized for disease management and proposed stepladder strategies.This review will discuss the updated roles of combination therapy,novel use of biologics as well as the recent use of adrenocorticotropic hormone(ACTH)analog in severe recalcitrant cases.
