眼部移植物抗宿主病(GVHD)是异基因造血干细胞移植(HCT)术后的严重并发症,轻者可以表现为眼部不适,重者可以出现严重的致盲性并发症。目前对于该病的治疗通常是循序渐进的,首先局部应用人工泪液及免疫抑制剂治疗,当症状不能缓解时考虑加用泪点栓塞、自体血清滴眼液及角膜或巩膜接触镜治疗,单用局部治疗对于症状较轻的患者效果往往较好。若患者眼表炎症持续进展,常需加用全身免疫抑制治疗。对于出现严重角膜病变的患者则需要考虑手术治疗,但此时由于眼部GVHD患者眼表炎症的持续存在,预后常常较差。随着对该病发病机制认识的深入,多种新型治疗方法如促泌剂、JAK/SYK抑制剂、曲尼司特、利非格斯、肝素、siRNA治疗及干细胞治疗已投入临床研究及应用,并取得了较好的治疗效果,本文将对眼部GVHD的治疗进展进行综述,以期为临床工作及研究提供参考。
Ocular graft-versus-host disease (GVHD) is a serious complication following hematopoietic cell transplantation (HCT). In mild cases, it can manifest as eye discomfort, while in severe cases, patients may suffer from vision loss.Ocular GVHD is often treated in a stepwise fashion, starting with artificial tears and immunosuppressive agents progressing to more aggressive interventions as needed.Topical therapy alone is often sufficient for patients with mild symptoms.If the ocular surface inflammation is still difficult to control, systemic immunosuppressive therapy is required.Patients with severe corneal disease should be considered for surgery, which often has a poor prognosis in the presence of ocular inflammation.With the deepening of the understanding of the pathogenesis of the disease, a variety of new therapies such as rebamipide, diquafosol, JAK/SYK inhibitors, tranilast, lifitegrast, heparin, siRNA therapy and stem cell therapy have been introduced into clinical research and application.This article reviews the current and emerging strategies for ocular GVHD to provide references for clinical practice and research.
王晶娆,张弘. 眼部移植物抗宿主病的治疗进展[J]. 中华实验眼科杂志,2023,41(11):1130-1134.
DOI:10.3760/cma.j.cn115989-20200904-00627版权归中华医学会所有。
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