神经营养性角膜炎:当前的挑战和未来的前景。

IF 3.1 Q1 OPHTHALMOLOGY Eye and Brain Pub Date : 2018-06-28 eCollection Date: 2018-01-01 DOI:10.2147/EB.S117261
Piera Versura, Giuseppe Giannaccare, Marco Pellegrini, Stefano Sebastiani, Emilio C Campos
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引用次数: 107

摘要

神经营养性角膜炎(NK)是一种由三叉神经角膜神经支配损伤引起的退行性角膜疾病,可导致自发上皮破坏和角膜溃疡。角膜感觉神经支配的损伤导致保护性反射和营养性神经调节剂的减少,而保护性反射和营养性神经调节剂对眼表组织的活力、代谢和伤口愈合至关重要。许多眼部和全身疾病,包括疱疹性角膜炎、眼部化学烧伤、角膜手术、糖尿病、多发性硬化症和神经外科手术,都可以通过破坏三叉神经支配引起NK。NK的诊断需要仔细调查与疾病相关的任何眼部和全身状况,进行完整的眼表检查,并定量测量角膜敏感性。NK的临床分期从角膜上皮改变(第1期)到持续性上皮缺损(第2期)和溃疡(第3期),后者可能发展为角膜穿孔。NK的管理是基于临床严重程度,治疗的目的是阻止角膜损伤的进展,促进上皮愈合。虽然已经提出了几种药物和手术治疗方法,但目前没有治疗方法可以恢复角膜敏感性,因此NK的治疗仍然困难且具有挑战性。本文综述了NK的发病机制、诊断和治疗的相关证据。新的医学和外科疗法,包括局部施用神经生长因子和角膜神经化也被描述。
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Neurotrophic keratitis: current challenges and future prospects.

Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of trigeminal corneal innervation, which leads to spontaneous epithelial breakdown and corneal ulceration. The impairment of corneal sensory innervation causes the reduction of both protective reflexes and trophic neuromodulators that are essential for the vitality, metabolism, and wound healing of ocular surface tissues. A wide range of ocular and systemic conditions, including herpetic keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis, and neurosurgical procedures, can cause NK by damaging trigeminal innervation. Diagnosis of NK requires careful investigation of any ocular and systemic condition associated with the disease, complete ocular surface examination, and quantitative measurement of corneal sensitivity. The clinical stages of NK range from corneal epithelial alterations (stage 1) to persistent epithelial defect (stage 2) and ulcer (stage 3), which may progress to corneal perforation. Management of NK is based on clinical severity, and the aim of the therapy is to halt the progression of corneal damage and promote epithelial healing. Although several medical and surgical treatments have been proposed, no therapies are currently available to restore corneal sensitivity, and thus, NK remains difficult and challenging to treat. The purpose of this review is to summarize available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel medical and surgical therapies including the topical administration of nerve growth factor and corneal neurotization are also described.

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来源期刊
Eye and Brain
Eye and Brain OPHTHALMOLOGY-
CiteScore
7.90
自引率
2.30%
发文量
12
审稿时长
16 weeks
期刊介绍: Eye and Brain is an international, peer-reviewed, open access journal focusing on basic research, clinical findings, and expert reviews in the field of visual science and neuro-ophthalmology. The journal’s unique focus is the link between two well-known visual centres, the eye and the brain, with an emphasis on the importance of such connections. All aspects of clinical and especially basic research on the visual system are addressed within the journal as well as significant future directions in vision research and therapeutic measures. This unique journal focuses on neurological aspects of vision – both physiological and pathological. The scope of the journal spans from the cornea to the associational visual cortex and all the visual centers in between. Topics range from basic biological mechanisms to therapeutic treatment, from simple organisms to humans, and utilizing techniques from molecular biology to behavior. The journal especially welcomes primary research articles or review papers that make the connection between the eye and the brain. Specific areas covered in the journal include: Physiology and pathophysiology of visual centers, Eye movement disorders and strabismus, Cellular, biochemical, and molecular features of the visual system, Structural and functional organization of the eye and of the visual cortex, Metabolic demands of the visual system, Diseases and disorders with neuro-ophthalmic manifestations, Clinical and experimental neuro-ophthalmology and visual system pathologies, Epidemiological studies.
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