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角膜缘干细胞缺乏的诊断标准-一个系统的文献回顾 Diagnostic criteria for limbal stem cell deficiency-a systematic literature review

Jawaheer L, Anijeet D, Ramaesh K

期刊名称:Survey of Ophthalmology



摘要:角膜缘干细胞缺乏症(LSCD)的诊断通常基于是否采用了相关测试来证明在角膜缘表面上存在杯状细胞或特定上皮标记物这些临床表现。本项系统性综述着重介绍了在所公开的各项介入研究中关于LSCD诊断的各种方法。本项研究属于一篇系统性文献综述。我们对200311日至20131231日期间以英文发表的文章进行了MEDLINEPUBMED的系统搜索。并收集了用于诊断LSCD的各项诊断方法数据(这些数据包括:临床表现,结膜印迹细胞学检查,各种上皮标志物的免疫组化检查,或体内共焦显微镜检查)。其中,46项研究(主要是回顾性/介入性病例系列)符合纳入标准。并且所有研究均采用临床特征作为LSCD的证据:眼部不适,视力受损,不规则上皮,不稳定泪膜,持续上皮缺损,瘢痕形成,血管翳,新生血管形成,角质化,钙化和角膜不透明。有18项研究(39.1%)还采用了其它检测用于诊断LSCD; 17例研究(37.0%)采用了杯状细胞的印迹细胞学检查,4项研究(8.7%)采用了上皮标志物的免疫组织化学分析,2项研究(4.3%)采用了invivo共聚焦显微镜检查。在大多数情况下,LSCD诊断仅通过临床表现来认定。在一些研究中,也会采用诊断测试,但不同的研究差异很大。因此,要比较各种干预措施的有效性则需要标准化的诊断方法。对LSCD的诊断标准达成共识是必要的,这需要由感兴趣的医疗服务提供者来达成。


The diagnosis of limbal stem cell deficiency (LSCD) is often based on clinical manifestations with or without the use of tests to demonstrate the presence of goblet cells or of specific epithelial markers on the corneolimbal surface. This systematic review looks at the various diagnostic methods used in the diagnosis of LSCD in published interventional studies. The design is a systematic literature review. We did a systematic search on MEDLINE and PUBMED for articles published in English between January 1, 2003, and December 31, 2013. We collected data on diagnostic methods used to diagnose LSCD (clinical findings, impression cytology, immunohistochemistry for various epithelial markers, or invivo confocal microscopy). Forty-six studies (mostly retrospective/interventional case series) met the inclusion criteria. All of the studies used clinical features as evidence of LSCD: discomfort, impaired vision, irregular epithelium, unstable tear film, persistent epithelial defects, scarring, fibrovascular pannus, neovascularization, keratinization, calcification, and opacification of the cornea. Eighteen studies (39.1%) used an additional test for the diagnosis; 17 studies (37.0%) used impression cytology for goblet cells, 4 studies (8.7%) used immunohistochemistry for epithelial markers, and 2 studies (4.3%) use invivo confocal microscopy. The diagnosis of LSCD was made in most cases on clinical grounds alone. In some studies, diagnostic tests were used, but these varied considerably from study to study. Comparison of effectiveness of various interventions requires standardized diagnostic methods. Consensus on the diagnostic criteria for LSCD is essential and needs to be reached by the interested care providers.


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