免疫性周边溃疡性角膜炎:系统免疫调节联合手术治疗的可行性  

Immune-associated peripheral ulcerative keratitis:feasibility of systemic immunomodulation combined with surgical treatment

作　　者：刘晓涵 陈颖欣 高明宏 Liu Xiaohan;Chen Yingxin;Gao Minghong(Graduate School of Dalain Medical University,Dalian 116000,Liaoning Province,China;General Hospital of Northern Theater Command,Shenyang 110000,Liaoning Province,China)

机构地区：[1]大连医科大学研究生院,辽宁省大连市116000 [2]中国人民解放军北部战区总医院,辽宁省沈阳市110000

出　　处：《中国组织工程研究》2025年第26期5713-5720,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:免疫性周边溃疡性角膜炎如果未及时发现及治疗,会导致角膜变薄、溃疡甚至穿孔,进而引起患者视力受损,影响生活质量。目的:讨论免疫性周边溃疡性角膜炎的发病机制,总结该疾病的最新诊疗方法。方法:以“Peripheral Ulcerative Keratitis,immunity,Immune system disease,pathogenesis,immunomodulatory therapy,surgical treatment,keratoplasty”为英文检索词,以“边缘性角膜溃疡,免疫,免疫系统疾病,发病机制,系统免疫调节治疗,手术治疗,角膜移植手术”为中文检索词,检索中国知网、万方数据库、EI数据库和PubMed数据库建库至2024年10月期间的相关文献,最终纳入68篇文献对免疫性周边溃疡性角膜炎目前的研究进展进行全面阐述。结果与结论:免疫性周边溃疡性角膜炎包括蚕食性角膜溃疡、睑缘炎相关角膜结膜病、上方角膜缘角结膜炎和自身免疫性疾病相关的周边溃疡性角膜炎。由于角膜缘的生理学特性,周边溃疡性角膜炎通常与免疫反应有关,其病理生理学机制通常与免疫复合物在角膜缘处血管沉积并产生微血管炎相关。无论在免疫性周边溃疡性角膜炎发病前是否确诊自身免疫性疾病,均应全身使用系统免疫调节治疗,这有助于减少与全身炎症相关的眼部并发症。非手术治疗如系统免疫调节治疗有利于眼部症状的缓解,当非手术治疗无效或病变浸润角膜深度达后弹力层时会引起角膜穿孔,联合手术治疗有助于保持眼球结构的完整性,但系统免疫调节联合手术治疗在免疫性周边溃疡性角膜炎的疾病发展中尚无明确的治疗指南。BACKGROUND:If not detected and treated in a timely manner,immune-associated peripheral ulcerative keratitis can lead to corneal thinning,ulcers and even perforation,thereby causing visual loss and affecting the patient’s quality of life.OBJECTIVE:To discuss the pathogenesis of immune-associated peripheral ulcerative keratitis and summarize the diagnosis and treatment ideas and the latest treatment methods for this disease.METHODS:Search terms were“peripheral ulcerative keratitis,immunity,immune system disease,pathogenesis,immunomodulatory therapy,surgical treatment,keratoplasty”in English and Chinese.Relevant literature on peripheral ulcerative keratitis published from database inception to October 2024 was searched by computer in CNKI,WanFang,PubMed,and EI databases.A total of 68 papers were ultimately selected to comprehensively describe the new research progress in the research on immune-associated peripheral ulcerative keratitis.RESULTS AND CONCLUSION:Immune-associated peripheral ulcerative keratitis includes Mooren’s ulcer,blepharokeratoconjunctivitis,superior limbic keratoconjunctivitis,and autoimmune related peripheral ulcerative keratitis.Due to the physiology of the corneal limbus,peripheral ulcerative keratitis is usually associated with an immune response,and the pathophysiologic mechanism is usually related to the deposition of immune complexes in the blood vessels at the limbus and the production of microangiitis.Systemic immunomodulatory therapy should be used whether or not an autoimmune disease is diagnosed prior to the onset of immune-associated peripheral ulcerative keratitis,which can help to reduce ocular complications associated with systemic inflammation.Nonsurgical treatment,such as immunomodulatory therapy,is beneficial for relieving ocular symptoms,but when nonsurgical treatment is ineffective or the lesion infiltrates the Descemet membrane,it can cause corneal perforation.Combined surgical treatment can help maintain the structural integrity of the eyeball.However,there is no cle

关 键 词：边缘性角膜溃疡 发病机制 自身免疫性疾病 角膜缘 系统免疫调节治疗 角膜移植手术 板层角膜移植术 脱细胞角膜基质 工程化组织构建 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R771.3