干眼在全球的患病率日益升高,发病机制复杂,疾病呈慢性过程且治疗效果欠佳。目前认为干眼是多因素导致的眼表疾病,不同致病因素所致的泪膜不稳定和泪液高渗透压、眼表炎症反应、眼表组织神经感觉异常是其主要自然病理过程,由于多种因素参与致病及病情多样化的特点,因此单一的治疗方法疗效不佳。研究发现氧化应激与干眼的发生密切相关,互为因果。当泪膜稳定性下降时,氧化应激系统产生的活性氧分子可损伤眼表神经髓鞘和破坏泪膜脂质层稳态,从而诱发或加重眼表的炎症反应。抗氧化疗法旨在靶向干眼发病的关键因素,阻断干眼炎症反应各环节的恶性循环,缓解患者的病情。目前,国际上的抗干眼创新药物研究已逐渐聚焦于抗炎、抗氧化药物的研发,且在靶向氧化应激生物标志物、线粒体靶向药物、黏液素分泌促进剂、糖蛋白硒和乳铁蛋白等抗氧化酶以及多功能纳米制剂等方面取得了一定进展,其中基于纳米材料开发的抗氧化滴眼液具有更好的优势,预测抗氧化治疗是干眼临床研究的未来方向之一。眼科医师和研究者应充分认识和关注干眼抗氧化治疗的研究进展及其新药的研发,并积极参与相关研究。
Dry eye is becoming more common worldwide.Its pathophysiology is complicated, and its condition is chronic.Treatment options of dry eye are ineffective.As a multifactorial ocular surface disease, tear film instability, tear hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities resulted from various causes are main natural pathological processes of dry eye.This multifactorial process of the disease leads to poor efficacy of single anti-inflammatory therapy.Oxidative stress is closely related to the occurrence of dry eye.During the decrease of tear film stability, reactive oxygen species produced by oxidative stress system damage the myelin sheath of ocular nerve and the lipid layer of tear film, inducing or aggravating the ocular inflammatory response.Targeting the main causes of dry eye's pathogenesis, stopping the vicious cycle of inflammatory responses in each link, and relieving patients' conditions are the main goals of antioxidant therapy.The development of anti-inflammatory and antioxidant medications is currently the main focus of international research on novel anti-dry eye medications.Some progresses have been made in the area of targeting oxidative stress biomarkers, mitochondrial targeting medications, mucin secretion, antioxidant enzymes like glycoprotein selenium and lactoferritin, as well as multifunctional nanoagents, and the antioxidant eye drops using nanomaterials have more advantages.Antioxidant treatment may be one of the potential future avenues of dry eye clinical research.Ophthalmologists and researchers should be fully aware of, pay close attention to and actively participate in investigations that are relevant to dry eye antioxidant therapy and the development of new medications.
洪佳旭,徐建江,周旭娇. 关注干眼抗氧化治疗及其新药研究[J]. 中华实验眼科杂志,2022,40(12):1119-1124.
DOI:10.3760/cma.j.cn115989-20220303-00086版权归中华医学会所有。
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