巨细胞病毒性角膜内皮炎患者角膜移植术后的药物治疗  

Drug therapy after corneal transplantation in patients with cytomegalovirus corneal endotheliitis

作　　者：张选俊(综述) 洪晶(审校)[1] Zhang Xuanjun;Hong Jing(Department of Ophthalmology,Peking University Third Hospital,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve,Beijing 100191,China)

机构地区：[1]北京大学第三医院眼科,眼部神经损伤的重建保护与康复北京市重点实验室,北京100191

出　　处：《中华实验眼科杂志》2023年第10期1028-1032,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(81970768)。

摘　　要：巨细胞病毒(CMV)是导致角膜内皮炎主要的病原体之一,病情严重致角膜透明性无法恢复时需要进行角膜移植。移植失败的主要原因是病毒感染复发和免疫排斥反应,术后合理的药物治疗是决定患者预后的关键。CMV角膜内皮炎患者接受角膜移植后应长期使用抗病毒药物预防复发,出现不明原因的内皮失代偿时要重视CMV角膜内皮炎的诊断和治疗。局部使用糖皮质激素是预防免疫排斥反应的主要手段。由于排斥反应发生率较低和病毒复发风险增加,对于接受内皮移植的患者,可以考虑减少使用甚至不用免疫抑制剂。本文对CMV角膜内皮炎患者角膜移植术后不同的抗病毒及抗排斥用药方案进行综述,以期寻找较为有效且合理的方案,为临床治疗提供参考。Cytomegalovirus(CMV)is a primary pathogen causing corneal endotheliitis,which may necessitate corneal transplantation if corneal transparency can not be restored.Recurrence of CMV infection and immune rejection are the main causes of graft failure,emphasizing proper postoperative drug therapy to improve the prognosis of patients.Long-term use of antiviral medications is necessary in order to prevent viral recurrence for patients suffering from CMV corneal endotheliitis who have undergone corneal transplantations.When unexplained endothelial decompensation occurs after corneal transplantation,the diagnosis and treatment of CMV endotheliitis must be emphasized.Topical use of glucocorticoids is the main means to prevent immune rejection.Due to the lower incidence of rejection and increased risk of viral recurrence,reducing or even eliminating the use of immunosuppressants may be considered for patients receiving endothelial keratoplasty.In this paper,different antiviral and anti-rejection drug regimens for patients who have undergone corneal transplantation were reviewed to find more effective and reasonable regimens and provide references for clinical treatment.

关 键 词：巨细胞病毒 角膜内皮炎 角膜移植 抗病毒药 免疫抑制剂 

分 类 号：R779.6[医药卫生—眼科]