综述
ENGLISH ABSTRACT
复发性角膜上皮糜烂治疗方法的临床选择
林兰若
朱思泉 [综述]
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20200331-00228
Clinical choice of treatment regimens for recurrent corneal erosion
Lin Lanruo
Zhu Siquan
Authors Info & Affiliations
Lin Lanruo
Sixth Clinical Medical College, Capital Medical University, Beijing 100029, China
Lin Lanruo is working at the Department of Ophthalmology, First Clinical Medical College, Peking University Health Science Center, Beijing 100034, China
Zhu Siquan
Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
·
DOI: 10.3760/cma.j.cn115989-20200331-00228
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摘要

复发性角膜上皮糜烂(RCE)是以角膜上皮反复剥脱所致的晨起突发眼痛为特征的常见疾病,发病原因众多,以外伤所致者多见,其次是上皮基底膜营养不良。临床上通过特征性病史、眼部症状和裂隙灯显微镜下表现可以做出诊断。RCE治疗方案主要分为保守治疗和手术治疗,初发者首选保守治疗,包括药物疗法、角膜绷带镜应用、血清滴剂点眼、低温保存羊膜覆盖等,保守治疗无效者根据患者情况选择不同的手术治疗,主要有上皮清创术、金刚石打磨抛光术、前基质针刺术、乙醇上皮分离术、准分子激光治疗性角膜切削术、准分子激光屈光性角膜切削术、飞秒激光辅助角膜板层切除术等。本文就RCE治疗方法的进展进行全面综述,以期为RCE临床治疗方案的选择提供参考。

角膜疾病;角膜上皮;治疗;复发性角膜上皮糜烂;角膜绷带镜;准分子激光治疗性角膜切削术
ABSTRACT

Recurrent corneal erosion (RCE), a common disease caused by repeated episodes of corneal epithelial defects, is characterized by the sudden onset of eye pain, usually upon first awakening.Among many causes of the disease, trauma is the most common one, followed by epithelial basement membrane dystrophy.The disease can be diagnosed via the characteristic medical history, ocular symptoms and slit-lamp examination.Treatment of RCE includes both conservative management and surgical management.Conservative treatment is the first choice for the primary patients, including medication, bandage contact lens, application of serum drops, coverage of cryopreserved amniotic membrane, etc.The appropriate surgical procedures should be performed in patients when the conservative therapy failed.Surgical treatment mainly includes epithelial debridement, diamond burr polishing, anterior stromal puncture, alcohol delamination, phototherapeutic keratectomy, photorefractive keratectomy, femtosecond laser-assisted lamellar keratectomy, etc.RCE treatment progress was comprehensively reviewed in this article to provide references for clinical therapy.

Corneal diseases;Epithelium, corneal;Therapeutics;Recurrent corneal erosion;Contact lenses, bandage;Phototherapeutic keratectomy
Zhu Siquan, Email: mocdef.qabquhznauqiS
引用本文

林兰若,朱思泉. 复发性角膜上皮糜烂治疗方法的临床选择[J]. 中华实验眼科杂志,2022,40(02):187-192.

DOI:10.3760/cma.j.cn115989-20200331-00228

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复发性角膜上皮糜烂(recurrent corneal erosion,RCE)也称复发性角膜糜烂综合征,是以反复发生角膜上皮剥脱导致晨醒后眼痛和流泪为特征的一种常见眼部疾病。RCE发病年龄为14~80岁,主要影响40岁以上的成年人,男女患病率尚未证实有显著差异。RCE的常见病因是角膜外伤,以角膜表层擦伤为主,眼化学伤和热灼伤后角膜缘干细胞遭到破坏也会发生RCE,其次是上皮基底膜营养不良(epithelial basement membrane dystrophy,EBMD),也可见于格子状角膜营养不良、颗粒状角膜营养不良、角膜退行性病变(如带状角膜变性)、角膜屈光手术及其他眼部手术后。患有干眼、糖尿病、睑缘炎和眼部玫瑰痤疮的患者RCE发生率较正常人高 [ 1 , 2 , 3 , 4 ]。目前RCE的治疗方法很多,主要包括保守治疗和手术治疗,临床上如何根据患者情况选择恰当的治疗方法以促进角膜上皮愈合、减轻痛苦、提高生活质量、减少或避免复发,仍然是眼科界面临的难题和挑战。本文就RCE治疗方法的进展和选择进行综述,以期为RCE临床治疗方案的选择提供参考。
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