春季角结膜炎(VKC)是一种慢性变应性角结膜炎,常见于学龄期儿童,临床上根据病变累及的组织分为睑结膜型、角膜缘型及混合型。尽管不同类型的变应性结膜炎大多数不引起视力下降,但VKC除了引起结膜病变外还可能发生角膜损害,进而导致视力下降,年龄较小的儿童一旦发生角膜损害还可能导致弱视。虽然VKC疾病名称似有季节性指向,但研究发现20%~60%的患者可能会全年发病,误诊或者不规范的治疗可引起病情迁延甚至导致眼部并发症。既往认为VKC是一种Ⅰ型和Ⅳ型超敏反应共同参与的疾病,目前发现免疫学因素、遗传因素和内分泌因素均参与疾病的发生和发展。VKC的诊断主要依据患者主观症状、角膜和结膜的特征性体征、激光共焦显微镜下组织中树突状细胞浸润和变应原检测试验。VKC的治疗以药物对症治疗为主,除了常规抗过敏、抗炎及人工泪液治疗,免疫抑制剂治疗成为新的趋势。本文对发病机制和治疗研究进展进行综述。
Vernal keratoconjunctivitis (VKC) is a chronic, bilateral allergic conjunctivitis common in school children.VKC is classified into palpebral-conjunctival type, limbal type and mixed type primarily based on clinical findings.Most allergic conjunctivitis does not impair vision, however, VKC probably causes visual impairment because of the involvement of cornea besides conjunctiva.Corneal lesions of VKC would lead to amblyopia in younger children.The term "vernal" in VKC indicates a seasonal onset, but 20%-60% patients are found onset throughout the year.In addition, misdiagnosis and improper treatment often lead to persistence or recurrence of VKC and other complications.Previous study has suggested that VKC is a hypersensitivity disease involved both type I and type IV, however, recent researchers found that immune factor, genetic factor and endocrine factor show close associations with the pathogenesis of VKC.The diagnosis of VKC depends on the clinical symptoms, pathological findings, infiltration of dendritic cells by laser scanning confocal microscopy and allergen tests.The treatment of VKC mainly focuses on symptom relief.In addition to anti-allergy, anti-inflammation and artificial tears, immunosuppressor has become a new trend.The pathogenesis and treatment progress of VKC are reviewed.
李素霞,史伟云. 春季角结膜炎的发病机制及治疗研究进展[J]. 中华实验眼科杂志,2022,40(05):481-486.
DOI:10.3760/cma.j.cn115989-20220413-00159版权归中华医学会所有。
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