角膜内皮功能紊乱的易患因素  

Risk factors for corneal endothelium dysfunction

作　　者：王霜宁 李霞[1] 

机构地区：[1]广西医科大学第一附属医院眼科,南宁530021

出　　处：《中华实验眼科杂志》2017年第7期669-672,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目（81060076、81360144）;教育部留学回国人员启动基金项目（2010-1561）

摘　　要：角膜内皮细胞密度是临床医师评估角膜内皮功能最常用的项目，但角膜内皮功能紊乱却没有得到相应的重视。近年来对各种眼部原发疾病、角膜移植术后等所致角膜内皮功能紊乱的临床数据有了更翔实的更新。眼部原发病中，各种类型的青光眼对角膜内皮的影响不尽相同，其中急性闭角型青光眼对角膜的损伤程度较慢性闭角型青光眼及开角型青光眼严重，青光眼不同的治疗方案对内皮的影响也各有特点。葡萄膜炎患者角膜内皮损伤的严重程度与炎症复发频数、炎症反应程度及病程密切相关。剥脱综合征患者前房含氧量低、细胞外纤维物质在眼前段的堆积、细胞发生纤维化改变等因素均可降低角膜内皮的功能，导致剥脱综合征患者角膜内皮细胞对损伤的耐受性差。对于角膜移植术后的患者，角膜移植排斥反应、手术方式、原发病、继发性晚期角膜内皮衰竭是角膜移植术后患者角膜内皮功能紊乱的重要因素。糖尿病是引起角膜内皮细胞储备能力下降的常见的全身性疾病，糖尿病患者细胞膜Na＋/K＋-ATP酶泵的功能降低、大量的晚期糖基化终产物的生成、代谢应激作用增强等因素均可降低角膜内皮创伤修复及愈合能力。本文就角膜内皮功能紊乱的易患因素进行综述，以帮助临床医师理解及重视该因素在内眼手术前的评估。Density of corneal endothelium is commonly used by clinician to evaluate the function of corneal endothelium. The importance of dysfunction of this layer has not been received enough attention in routine clinical works. Recently,dysfunction of corneal endothelium due to the ocular diseases and corneal transplantation has been updated. Different types of glaucoma cause different degrees of damage to the corneal endothelium. Among them,the most serious damage to the corneal endothelium is acute angle closure glaucoma. Different treatment patterns of glaucoma damage to endothelium also have different features. The occurrence frequency, severity of the inflammation and the course of uveitis are the important factors which affect the corneal endothelium. The pathologic changes of pseudoexfoliation syndrome includes hypoxic changes in the anterior chamber, deposition of extracellular matrix in anterior segment and fibroblastic changes of the endothelium. These pathologic changes can decrease the endothelium function and the tolerance of injury. For keratoplasty, corneal immunologic rejection, surgical options, the primary disease and secondary late endothelial failure are the important factors of corneal endothelium dysfunction. Diabetes is a common systemic disease that cause corneal endothelium reserve capacity reduced. The decreasing of Na＋/K＋- ATPase activity,the accumulation of advanced glycation end products,constant metabolic stress can reduce corneal endothelium wound-healing ability. Recent researches of risk factors for corneal endothelium dysfunction were summarized in this paper to help clinician understand and value assess this element before intraocular surgery.

关 键 词：角膜内皮 功能紊乱 易患因素 

分 类 号：R772.2[医药卫生—眼科]