角膜神经移植在神经营养性角膜病治疗中的应用  

Application of corneal neutrotization in the treatment of neurotrophic keratopathy

作　　者：徐三华(综述) 吴洁丽(审校)[2] 邵毅(审校)[1,3] Xu Sanhua;Wu Jieli;Shao Yi(Department of Ophthalmology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Xiamen University Eye Institute,Xiamen 361102,China;Department of Ophthalmology,Eye&ENT Hospital of Fudan University,Shanghai 200030,China)

机构地区：[1]南昌大学第一附属医院眼科,南昌330006 [2]厦门大学眼科研究所,厦门361102 [3]复旦大学附属眼耳鼻喉科医院眼科,上海200030

出　　处：《中华实验眼科杂志》2024年第3期297-300,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：中央引导地方科技发展资金(20211ZDG02003);江西省重点研发项目(20181BBG70004、20203BBG73059)。

摘　　要：神经营养性角膜病变(NK)是一种退行性疾病,其中角膜神经受损导致角膜感觉减退,严重者可致失明。传统的NK治疗旨在支持角膜愈合和防止角膜损伤的进展。近年来,角膜神经移植在NK中取得了一些进展。与传统治疗相比,角膜神经移植不仅能解决角膜神经缺损的问题,从而避免后续发生的角膜病变;还能显著恢复角膜敏感性、角膜上皮和视力等。角膜神经移植手术主要分为直接角膜神经移植和间接角膜神经移植两大类。如今,该手术方法已逐渐用于临床,并在疱疹病毒和神经瘤引起的单侧NK以及双侧NK上取得了令人满意的临床疗效。然而,对于干眼、糖尿病和慢性青光眼等引起的NK的手术治疗知之甚少。未来可通过多中心前瞻性随机研究来进一步完善针对NK的病因治疗。本文将从角膜神经移植手术的具体术式、手术方式的选择以及手术的时机三个方面介绍这一新型外科技术。Neurotrophic keratopathy(NK)is a degenerative disease in which damage to the corneal nerves leads to corneal hypoesthesia and even blindness.Traditional NK treatments aim at supporting corneal healing and preventing progression of corneal damage.In recent years,corneal neurotization has made some progress in NK.Compared with traditional treatment,it can not only solve the problem of corneal nerve defect,and avoid the subsequent keratopathy,but also significantly restore corneal sensitivity,corneal epithelium and vision.Corneal neurotization surgery methods are mainly divided into direct corneal neurotization(DCN)and inderect corneal neurotization(ICN).At present,this surgical method has gradually been used clinically,and has achieved satisfactory effects on unilateral NK caused by herpes virus and neuroma,as well as bilateral NK.However,it is little known about the surgical treatment of NK caused by dry eye,diabetes,and chronic glaucoma.In the future,multi-center prospective randomized studies can be conducted to further improve the treatment of NK with other causes.This article introduces this new surgical technique from three aspects,the specific surgical procedures of corneal neurotization,the selection of surgical methods,and the timing of the operation.

关 键 词：神经再生 神经营养性角膜病 角膜神经移植 神经结合 角膜感觉 疱疹性角膜病 

分 类 号：R772.2[医药卫生—眼科]