HSK合并白内障行超声乳化术后的疗效及临床用药观察

目的:观察单纯疱疹病毒性角膜炎(Herpes simplex keratitis,HSK)合并白内障患者行白内障超声乳化术后视力变化及术后应用抗病毒药物预防单纯疱疹病毒性角膜炎复发的疗效。方法:单纯疱疹病毒性角膜炎合并白内障22例22眼行白内障超声乳化+人工晶状体植入术,术后随机分为两组,治疗组给予口服阿昔洛韦及滴用更昔洛韦凝胶;对照组仅给予滴用更昔洛韦凝胶。观察术后视力变化情况;分析单纯疱疹病毒性角膜炎复发的情况。结果:术后6mo随访,治疗组和对照组视力均获得提高;治疗组无1例出现单纯疱疹病毒性角膜炎的复发;对照组也仅有1例于术后6mo复发,差异无显著性。结论:在抗病毒药物的保护下,>6mo未复发的单纯疱疹病毒性角膜炎不是白内障的手术禁忌,白内障手术能有效改善HSK合并白内障患者的视力;仅滴用更昔洛韦凝胶亦能有效预防白内障术后单纯疱疹病毒性角膜炎的复发。     

单纯疱疹病毒性角膜炎实验室诊断技术

单纯疱疹病毒性角膜炎实验室诊断技术白求恩医科大学第一临床医院眼科杜鹃，徐杰锦州医学院附属第一医院眼科刘丹单纯疱疹病毒性角膜炎（ＨＳＫ）是目前世界上主要致盲疾病之一，诊断主要依据角膜病变形态及临床症状。但由于其反复发作的特点常致病变不典型，造成诊断上的...     

单纯疱疹性角膜炎继发青光眼的误诊

单纯疱疹性角膜炎继发青光眼的误诊冯金玲贾桂芹天津眼科医院（３０００４０）单纯疱疹性角膜炎（ＨＳＫ）为临床致盲率很高的常见病，继发青光眼并不多见，因此临床上常被漏诊或误诊。我院自１９８９年—１９９７年收治ＨＳＫ继发青光眼中６例误诊为原发青光眼，报告如下...     

单疱病毒性角膜炎继发青光眼

目的：探讨单纯疱疹病毒性角膜炎（herpes simplex keratitis,HSK）继发青光眼的诊治方法和疗效。方法：继发青光眼诊断标准为HSK患者眼压≥24mmHg。以角膜病变静止及停用降眼压药物1wk后眼压≤21mmHg为临床治愈。30例HSK继发青光眼患者给予综合抗病毒、抗炎及降眼压治疗。结果：单纯疱疹病毒性角膜炎继发青光眼患者30例经过抗病毒、抗炎及降眼压治疗均获临床治愈。结论：通过综合抗病毒与抗炎治疗HSK继发青光眼能迅速控制炎症与眼压。个体化的眼压测量对HSK继发青光眼的诊断是必要的。     

口服阿昔洛韦在单疱病毒性角膜炎行角膜移植术后的应用

目的　评价单纯疱疹病毒性角膜炎患者行穿透性角膜移植术后,口服阿昔洛韦预防单纯疱疹病毒性角膜炎复发的疗效。方法　1999年1月至2 0 0 3年12月单纯疱疹病毒性角膜炎5 2例5 2眼行穿透性角膜移植术,术后给予口服阿昔洛韦2 0 0mg 5次/d ,服用2m～3m后减为4 0 0mg 2次/d ,继续服用3m后停止,分析单纯疱疹病毒性角膜炎复发的情况。结果　在口服阿昔洛韦期间,无一例出现单纯疱疹病毒性角膜炎的复发。术后经12m～38m (2 2 .8±9. 6 )的随访,4 9眼植片透明,3眼因排斥反应植片混浊。32眼(6 1 .5 % )最佳矫正视力好于0 . 5 ,4 9眼(94 . 2 % )最佳矫正视力好于0 . 1,3眼(5 . 8% )低于0 . 1。结论　口服阿昔洛韦能有效预防单纯疱疹病毒性角膜炎行穿透性角膜移植术后的复发     

单纯疱疹病毒性角膜炎角膜组织病毒潜伏感染的PCR检测分析

 目的  探讨通过穿透性角膜移植获取的单纯疱疹病毒性角膜炎病变角膜组织中1型单纯疱疹病毒（HSV-1）DNA的表达情况及意义。设计 实验研究。研究对象  2010年5-12月北京同仁医院因病毒性角膜炎角膜白斑行穿透性角膜移植术后角膜标本20例,圆锥角膜、大泡性角膜病变和角膜营养不良等非感染性角膜病变的角膜标本20例。方法  对角膜组织标本中HSV-1 DNA进行聚合酶链反应（PCR）检测。 主要指标  HSV-1 DNA的阳性率。结果  单纯疱疹病毒性角膜炎静止期患者角膜组织中12/20例（60%）检出HSV-1 DNA,非感染性角膜组织中6/20例（30%）检出HSV-1 DNA（χ2=3.64,P=0.057）。结论  单纯疱疹病毒性角膜炎静止期角膜组织多数表达HSV-1 DNA,角膜内潜伏病毒是引起单纯疱疹病毒性角膜炎的可能原因,正常人角膜也可能有HSV-1的DNA存在。（眼科,2013,22：45-48）     

单纯疱疹病毒角膜潜伏感染的研究

利用多聚酶链反应等分子生物学方法，对１４例单纯疱疹病毒性角膜炎（其中１０例为静止期单纯疱疹病毒性角膜炎），１０例非单纯疱疹病毒性角膜病变及２例正常角膜组织中单纯疱疹病毒胸腺嘧啶核苷激酶基因（ＴＫ）部分序列进行扩增，发现在４例活跃期单纯疱疹病毒性角膜炎均显示出阳性扩增条带，而１０例静止期单纯疱疹病毒性角膜炎中有８例显示出阳性扩增条带（占８０％），非单纯疱疹病毒性角膜病变及正常角膜组织中均未检出单纯疱疹病毒ＴＫ基因序列。表明角膜可能是单纯疱疹病毒在三叉神经节外形成潜伏感染的一个部位。     

现代医学和传统医学对复发性HSK的研究进展

从近年来大量的研究文献可以看出,复发性单纯疱疹病毒性角膜炎一直是眼科学研究的一个热点,其发病机制及治疗药物的探索早已成为研究的焦点。随着医学研究的深入,我们对单纯疱疹性角膜炎有了新的认识,但目前对其具体发病机制和治疗手段尚不一致,还需进一步研究。     

阿昔洛韦及眼生素联合治疗单疱病毒性角膜炎

单纯疱疹病毒性角膜炎是眼科常见疾病,由单纯疱疹病毒感染引起,为严重的致盲眼病,居角膜致盲首位,不及时治疗将损害视力,甚至导致失明。我院自1999年以来采用阿昔洛韦注射用药及眼生素注射液联合治疗单疱病毒性角膜炎,效果满意,现报告如下。1　资料与方法1 1　一般资料　1999年     

新鲜羊膜移植治疗单纯疱疹病毒性角膜炎的初步研究

目的：探讨新鲜羊膜移植治疗单纯疱疹病毒性角膜炎的可行性、手术方法和治疗效果。方法：对本院收治的23例单纯疱疹病毒性角膜炎患(25眼)进行羊膜移植，手术方法有：单层羊膜覆盖术18例(20眼)，多层羊膜移植术5例(5眼)。术后随访6～12mo。结果：术后均未见新鲜羊膜植片急性排斥反应。术后3～15d炎症得到迅速有效的控制，眼部刺激症状消失，睫状体充血消退。视力有不同程度的提高。结论：对单纯疱疹病毒性角膜炎进行新鲜羊膜移植可以有效的控制炎症，迅速减轻局部症状，重建眼表，缩短病程，防止严重并发症的发生。     

重视单纯疱疹病毒性角膜炎内皮型的诊治

单纯疱疹病毒性角膜炎(HSK)是我国主要的致盲性眼病之一,包括上皮型、基质型及内皮型,其中HSK内皮型,目前临床分类多样,一些患者临床表现特殊,增加了诊断难度,同时也造成了治疗上的混乱.因此,建议把若干种HSK内皮炎归类为HSK内皮型,有利于制定并推广对HSK内皮型规范化治疗方案,提高治愈率,减少因误诊致角膜内皮细胞功能失代偿的几率,从而达到降低致盲率的目的.

Abstract：

Herpes simplex keratitis (HSK), including epithelial keratitis, stromal keratitis, and endotheliitis, is one of the major blinding eye diseases in China. Corneal herpetic endotheliitis has a variety of clinical manifestations, which causes much difficulty for diagnosis and treatment. This paper suggests a uniform classification of corneal herpetic endotheliitis, which helps to the set up and wide application of a standard treatment protocol. As a result, the cure rate would be increased significantly, corneal endothelium loss due to misdiagnosis would be reduced, and finally the blindness rate of HSK would be lowered.     

HSK的包膜糖蛋白gB和gD与疫苗的研究新进展

包膜糖蛋白gB,gD是参与单纯疱疹病毒（herpes simplex virus,HSV）感染的基本结构蛋白, 具有重要的抗原表位, 参与病毒穿膜过程,介导了病毒的细胞间扩散,在病毒感染和宿主免疫过程中起着重要作用,其分子和功能特性的研究对HSV作用机制及预防的研究有着重要意义。近年来,该领域的研究取得一定进展,针对HSVgB,HSVgD的抗原表位已研究出相应疫苗,本文将对与单纯疱疹病毒性角膜炎（herpes simples keratitis,HSK）有关的糖蛋白gB,gD与疫苗的研究进展做一简要综述。     

单纯疱疹病毒性角膜基质炎静止期泪膜改变的初步观察

目的 探讨单纯疱疹病毒性角膜基质炎(HSK)静止期患者泪膜稳定性变化.方法 前瞻性对照研究.连续收集2007年12月至2009年3月在厦门大学附属厦门眼科中心定期就诊的24例单眼患病的HSK静止期患者,行双眼基础泪液分泌试验(SIT)测试和泪膜破裂时间(BUT)检查,并调查其干眼主观症状.同期取28名正常人作为对照组,行SIT与BUT检查.对正常对照者及BUT≤5 s的患眼进行激光共焦角膜显微镜观察.应用SPSS 16.0软件进行临床资料的分布和方差齐性检验及组间差异的非参数检验(Kruskal-Wallis检验及Mann-Whitney检验).结果 91.7%HSK静止期患者(22/24例)出现至少1项干眼相关症状.与正常对照组比较,HSK静止期患者双眼SIT均降低[正常组(16.2±3.2)mm/5min,患眼(10.4±7.8)mm/5min,对侧眼(11.2±8.8)mm/5 min;对照与患病眼,U=135.0,P<0.001;对照与对侧眼,U=155.0,P=0.001],BUT缩短[正常组(12.1±0.7)8,患眼(4.3±3.3)s,对侧眼(9.2±4.4)s;对照与患病眼,U=28.0,P<0.001;对照与对侧眼,U=114.0,P<0.001].HSK患眼与对侧眼SIT相比较,差异无统计学意义(U=273.0,P=0.757);BUT明显缩短,差异有统计学意义(U=90.0,P<0.001).HSK患眼中58.3%(14/24例)S I T≤10 mm/5 min,95.8%(23/24例)BUT≤10 s;而在对侧眼其比例分别为58.3%(14/24例)及70.8%(17/24例).激光活体共焦显微镜检查显示12例泪膜异常的HSK静止期患眼的中央角膜表层上皮细胞明显增大伴细胞核高反光,角膜上皮下神经纤维密度降低,且出现明显的神经纤维串珠样改变等.结论 HSK静止期患者多存在泪膜改变,活体共焦显微镜检查显示泪膜功能异常者出现与干眼类似的角膜上皮细胞及上皮下神经纤维的形态学改变.     

Immunological aspects of herpetic stromal keratitis

Herpetic stromal keratitis (HSK) is an immune reaction related to herpes simplex virus (HSV) corneal infection, and has many important immunological aspects. CD4(+) T lymphocytes, especially Th1 cells, are the principal mediators for HSK. In addition, neutrophils and antigen-presenting cells play vital roles in HSK. CD8(+) T lymphocytes, B cells, and natural killer cells all participate in the pathogenesis of HSK under certain circumstances. Many molecules are involved in the pathogenesis of HSK. Th1 cytokines such as interleukin 2 (IL-2), IL-12 and interferon gamma, and inflammatory cytokines such as IL-1alpha and IL-6 are especially important ones. Among various chemokines that take part in HSK, MIP-1alpha is one of the most important aggravating factors. Vaccination therapy against HSK has been developed; glycoprotein D is a particularly promising candidate. However, the possibility of HSK exacerbation due to vaccination is the final problem to be solved before vaccination can be clinically applied to HSK. Molecular mimicry theory and bystander activation theory are the two new autoimmune theories that have been advocated. Since genuine autoimmune HSK without HSV growth can hardly be the case in clinical practice, some part of these new theories remains controversial. In the future, better understanding of the pathogenesis of HSK is essential to resolve the paradox between suppressing the immune reaction to avoid corneal scarring and preventing viral proliferation.     

Immunological Aspects of Herpetic Stromal Keratitis

Herpetic stromal keratitis (HSK) is an immune reaction related to herpes simplex virus (HSV) corneal infection, and has many important immunological aspects. CD4⁺ T lymphocytes, especially Th1 cells, are the principal mediators for HSK. In addition, neutrophils and antigen-presenting cells play vital roles in HSK. CD8⁺ T lymphocytes, B cells, and natural killer cells all participate in the pathogenesis of HSK under certain circumstances. Many molecules are involved in the pathogenesis of HSK. Th1 cytokines such as interleukin 2 (IL-2), IL-12 and interferon γ, and inflammatory cytokines such as IL-1α and IL-6 are especially important ones. Among various chemokines that take part in HSK, MIP-1α is one of the most important aggravating factors. Vaccination therapy against HSK has been developed; glycoprotein D is a particularly promising candidate. However, the possibility of HSK exacerbation due to vaccination is the final problem to be solved before vaccination can be clinically applied to HSK. Molecular mimicry theory and bystander activation theory are the two new autoimmune theories that have been advocated. Since genuine autoimmune HSK without HSV growth can hardly be the case in clinical practice, some part of these new theories remains controversial. In the future, better understanding of the pathogenesis of HSK is essential to resolve the paradox between suppressing the immune reaction to avoid corneal scarring and preventing viral proliferation.     

复发性单疱病毒性角膜炎实验模型的研究

目的：建立一种可靠、实用的复发性单疱病毒性角膜炎（HSK）的实验模型。方法：用单纯病毒I型（HSV－1）Mckrae株行NIH鼠的角膜接种,用人的抗HSV－1血清行鼠的腹腔内注射,使病毒在三叉神经节或角膜内建立起潜伏感染。用紫外线B光照射鼠的角膜,诱导HSK复发。观察诱导HSK复发的成功率、复发性HSK的临床特征、组织学特点。结果：紫外线照射诱导鼠HSK复发的成功率为72．5％,复发性HSK主要表现为基质型角膜炎,组织切片见角膜基质层内有大量的淋巴细胞和一些中性粒细胞浸润。     

Delayed Type Hypersensitivity in the Pathogenesis of Recurrent Herpes Stromal Keratitis

Recurrent herpes stromal keratitis (HSK) is one of the leading causes of blindness in the developed world. Cyokines characteristic of Th1 cells (in particular IFN-γ and IL-2) have been shown to dominate in HSK in addition to mechanisms by nonspecific, antigen-independent effector cells such as neutrophils, basophils, and monocytes. More recently, the migration and maturation of dendritic cells (DC) within the corneal stroma of patients with HSK have been recognized as contributors to recurrent disease, suggesting a role for delayed type hypersensitivity (DTH) in the immunopathogenesis of HSK. The role of DC and DTH in recurrent HSK has not been studied extensively and experimental models of recurrent HSK focusing on DTH as the pathogenesis and viral particles as the triggering antigen may contribute to better understanding of the disease.