虹膜角膜内皮综合征的研究进展

虹膜角膜内皮综合征(iridocorneal endothelial syndrome, ICES)是一种罕见的眼部疾病,是一组以角膜内皮、前房角和虹膜的结构及增生异常为特征的疾病。常见的临床特征包括角膜水肿、继发性青光眼、虹膜萎缩、瞳孔异常等。常发生于年轻女性,多单眼发病。其发病机制尚不明确,症状多样,且致盲率高。该疾病诊断困难,且尚无理想治疗方法。本文旨在回顾有关ICES的特点、诊断及治疗等方面的文献,以期对疾病的诊治提供帮助。     

共焦显微镜检查在角膜病的应用

共焦显微镜作为一种新型的光学显微镜已广泛应用于眼科临床 ,使得活体正常人角膜各层结构得以显示。各种屈光矫正方法 (角膜接触镜、PRK、LASIK)、角膜营养不良、角膜炎症、角膜移植手术后及虹膜角膜内皮综合征等引起的角膜病理变化均可通过共焦显微镜三维、实时、断层无损伤的检查 ,得以明确。共焦显微镜在角膜疾病的早期诊断及指导治疗上有其不可比拟的优越性。     

共焦显微镜检查在角膜病的应用

共焦显微镜作为一种新型的光学显微镜已广泛应用于眼科临床，使得活体正常人角膜各层结构得以显示。各种屈光矫正方法(角膜接触镜、PRK、LASIK)、角膜营养不良、角膜炎症、角膜移植手术后及虹膜角膜内皮综合征等引起的角膜病理变化均可通过共焦显微镜三维、实时、断层无损伤的检查，得以明确。共焦显微镜在角膜疾病的早期诊断及指导治疗上有其不可比拟的优越性。     

亚临床圆锥角膜的诊断和筛查研究进展

圆锥角膜是以角膜扩张变薄并呈锥形向前突起为特征的进展性角膜疾病。亚临床圆锥角膜缺乏临床表现及特征, 目前尚无明确可行的诊断标准。现笔者对近年来亚临床圆锥角膜诊断及筛查的研究进展, 包括角膜前后表面地形图、角膜生物力学、光学相干断层扫描(OCT)等检查的诊断参数、角膜形态学和生物力学的联合诊断参数的研究以及AI辅助的圆锥角膜诊断进行简要综述。     

亚临床圆锥角膜的诊断和筛查研究进展

圆锥角膜是以角膜扩张变薄并呈锥形向前突起为特征的进展性角膜疾病。亚临床圆锥角膜缺乏临床表现及特征,目前尚无明确可行的诊断标准。现笔者对近年来亚临床圆锥角膜诊断及筛查的研究进展,包括角膜前后表面地形图、角膜生物力学、光学相干断层扫描（OCT）等检查的诊断参数、角膜形态学和生物力学的联合诊断参数的研究以及AI辅助的圆锥角膜诊断进行简要综述。     

第七届全国角膜病及眼表疾病学术会议征文

由中华医学会眼科学分会角膜病学组及中华眼科杂志编委会主办的“第七届全国角膜病及眼表疾病学术会议”定于 2 0 0 3年 5月下旬在云南省昆明市召开 ,届时将邀请我国从事角膜和眼表疾病基础及临床研究的知名专家和学科带头人进行专题讲座 ,欢迎全国眼科医师踊跃报名参加。讲座内容 :(1)眼表疾病的分类、诊断及治疗 ;(2 )感染性角膜病的临床研究进展 ;(3)免疫性角膜病变的处理原则 ;(4)角膜病及眼表疾病的临床及应用基础研究方法 ;(5 )角膜病诊断及治疗的基因及组织工程技术 ;(6 )角膜病及眼表疾病治疗的药物研究进展 ;(7)角膜病及眼表疾病的…     

第七届全国角膜病及眼表疾病学术会议征文

由中华医学会中华眼科学分会角膜病学组协办及中华医学会中华眼科杂志主办的“第七届全国角膜病及眼表疾病学术会议”定于 2 0 0 3年 5月下旬在云南省昆明市召开 ,届时将邀请我国从事角膜和眼表疾病基础及临床研究的知名专家和学科带头人进行专题讲座 ,欢迎全国眼科医师踊跃报名参加。讲座内容 :(1)眼表疾病的分类、诊断及治疗 ;(2 )感染性角膜病的临床研究进展 ;(3)免疫性角膜病变的处理原则 ;(4)角膜病及眼表疾病的临床及应用基础研究方法 ;(5 )角膜病诊断及治疗的基因及组织工程技术 ;(6 )角膜病及眼表疾病治疗的药物研究进展 ;(7)角膜病…     

中国免疫相关性边缘性角膜病临床诊疗专家共识(2022年)

免疫相关性角膜病是由于全身或眼局部免疫功能异常,对自身正常角膜组织或变性角膜组织产生异常免疫应答反应,造成角膜和结膜结构和功能破坏,导致视力损伤的一类疾病,主要包括蚕蚀性角膜溃疡、睑缘炎相关角膜结膜病、类风湿性关节炎等全身免疫性疾病相关的边缘性角膜溃疡等。免疫相关性角膜病临床表现多样,病程反复迁延,误诊和漏诊率高,导致临床治疗预后不佳。为此,中华眼科学会眼科学分会角膜病学组针对边缘性免疫相关性角膜病的诊断、鉴别诊断及治疗原则进行充分讨论,结合国内外研究成果,达成共识性意见,以期对该类疾病的早期发现、早期干预和正确治疗发挥临床指导作用。     

中国免疫相关性边缘性角膜病临床诊疗专家共识(2022年)

免疫相关性角膜病是由于全身或眼局部免疫功能异常,对自身正常角膜组织或变性角膜组织产生异常免疫应答反应,造成角膜和结膜结构和功能破坏,导致视力损伤的一类疾病,主要包括蚕蚀性角膜溃疡、睑缘炎相关角膜结膜病、类风湿性关节炎等全身免疫性疾病相关的边缘性角膜溃疡等。免疫相关性角膜病临床表现多样,病程反复迁延,误诊和漏诊率高,导致临床治疗预后不佳。为此,中华眼科学会眼科学分会角膜病学组针对边缘性免疫相关性角膜病的诊断、鉴别诊断及治疗原则进行充分讨论,结合国内外研究成果,达成共识性意见,以期对该类疾病的早期发现、早期干预和正确治疗发挥临床指导作用。     

病毒性角膜内皮炎的研究现状

病毒性角膜内皮炎诱因多样,病因复杂,发病机制尚不完全明确,临床表现多样,目前无统一分类,辅助诊断技术不断提高,环媒恒温扩增法、各种PCR对疾病的诊断有一定的辅助作用。但在临床上还主要依靠临床表现、病史来诊断,其治疗临床上主要以抗病毒联合糖皮质激素为主,耐药病毒株越来越多,复发率高,迫切需要研究新药及新的治疗方法,基因工程药物比如疫苗、解旋-引物酶抑制剂、趋化因子受体等实验研究为病毒性角膜内皮炎的治疗带来希望。本文旨在对目前病毒性角膜内皮炎的相关研究作一综述。     

Corneal Pain without Stain: Is it Real?

Clinicians often encounter patients who report corneal pain suggestive of dry eye disease, yet lack equivalent signs. These patients represent a diagnostic and therapeutic challenge that is more easily dismissed than addressed. We review the physiology of pain and the pathophysiological mechanisms of neuropathic corneal pain and speculate on the mechanisms of certain etiopathogenic triggers, such as LASIK, severe dry eye disease, and Sjogren syndrome. Recognizing corneal neuropathic pain as a disease in its own right is the first step toward developing more effective treatments for these severely disabled and presently inadequately served patients.     

Neuropathic ocular pain: an important yet underevaluated feature of dry eye

Dry eye has gained recognition as a public health problem given its prevalence, morbidity, and cost implications. Dry eye can have a variety of symptoms including blurred vision, irritation, and ocular pain. Within dry eye-associated ocular pain, some patients report transient pain whereas others complain of chronic pain. In this review, we will summarize the evidence that chronicity is more likely to occur in patients with dysfunction in their ocular sensory apparatus (ie, neuropathic ocular pain). Clinical evidence of dysfunction includes the presence of spontaneous dysesthesias, allodynia, hyperalgesia, and corneal nerve morphologic and functional abnormalities. Both peripheral and central sensitizations likely play a role in generating the noted clinical characteristics. We will further discuss how evaluating for neuropathic ocular pain may affect the treatment of dry eye-associated chronic pain.     

干眼与眼部神经病理性疼痛相关性进展

干眼（dry eye，DE）是一种常见的多因子眼表疾病，具有较高的发病率。DE的症状包括视力模糊、刺激和眼部疼痛。研究表明，DE和神经病理性疼痛在流行病学、发病机制和临床表现上有许多相似之处。本文综述了DE与眼部神经病理性疼痛的相似处，重点介绍临床特征、眼部神经性疼痛评估及治疗方法。     

Neuropathic pain and dry eye

Dry eye is a common, multifactorial disease currently diagnosed by a combination of symptoms and signs. Its epidemiology and clinical presentation have many similarities with neuropathic pain outside the eye. This review highlights the similarities between dry eye and neuropathic pain, focusing on clinical features, somatosensory function, and underlying pathophysiology. Implications of these similarities on the diagnosis and treatment of dry eye are discussed.     

Fotofobia y dolor neuropático en el síndrome de Sudeck

The case is presented of a 14 year-old patient diagnosed with Sudeck's syndrome secondary to uneventful foot trauma. The patient complained of decreased visual acuity along with photophobia and intense ocular pain not correlated with the exploratory findings.Sudeck's syndrome is an idiopathic neuropathic inflammatory disease characterised by disproportionate pain, unrelated to a previous traumatic event, which can evolve to severe and generalised pain. A new explanation has recently described this as “neuropathic eye pain” for those patients with severe eye pain that do not correlate with clinical signs. In the case presented here, the pain became widespread and led to photophobia and very intense ocular neuropathic pain. It is believed that this was the cause of the visual decrease presented by this patient. It is proposed that the Sudeck syndrome should become part of the differential diagnosis of neuropathic eye pain.     

Concurrent ocular pain in patients with neurotrophic keratopathy

PurposeTo illustrate that ocular pain may occur in patients with neurotrophic keratopathy (NK) that typically are thought to lack symptoms of discomfort, and that aa subset of these patients may also present with neuropathic corneal pain (NCP).MethodRetrospective Case series of 7 stage 1 NK patients who presented with concurrent ocular pain, as confirmed by clinical examination, proparacaine challenge test, and in vivo corneal confocal microscopy (IVCM). Records were assessed for results of ocular surface disease index (OSDI), pain on visual analog scale (VAS), ocular pain assessment survey (OPAS), best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS) score, and IVCM findings. IVCM findings were compared to that of 20 healthy reference controls.ResultsMean age of patients was 63.7 ± 11.6 (range 44–76) years and 56.9 ± 8.6 (range 42–74) years in reference controls (p = 0.11). At presentation, ocular discomfort was 8.0 ± 1.3 (range 7–10) on VAS and mean OSDI scores were 72.26 ± 6.81 (range 62.50–79.54). Mean BCVA was 20/40, and mean CFS scores were 3.43 ± 0.79 (range 2–4) on the Oxford scale. IVCM analysis showed significant decrease in mean total, main and branch nerve densities in ranges consistent with NK as compared to normal controls (p < 0.001 for all), increased dendritiform cell density in three patients (p < 0.001), and the presence of microneuromas in six of the patients.ConclusionPatients with NK are thought to present with hypoesthesia. However, nerve damage and inflammation, which play a role in the development of NK may result in the development of chronic ocular pain, such as NCP, resulting in potential underdiagnosis of either disease.     

Corneal nerve tortuosity in diabetic patients with neuropathy

PURPOSE: Corneal confocal microscopy is a reiterative, rapid, noninvasive in vivo clinical examination technique capable of imaging corneal nerve fibers. Nerve fiber tortuosity may indicate a degenerative and attempted regenerative response of nerve fibers to diabetes. The purpose of this study was to define alterations in the tortuosity of corneal nerve fibers in relation to age, duration of diabetes, glycemic control, and neuropathic severity. METHODS: The cornea and collected images of the subbasal nerve plexus of 18 diabetic patients (stratified into mild, moderate, and severe neuropathic groups using conventional clinical measures of neuropathy) and 18 age-matched nondiabetic control subjects were scanned, and a novel mathematical paradigm was applied to quantify the extent of nerve tortuosity, which was termed the tortuosity coefficient (TC). RESULTS: TC was significantly different between the four clinical groups (F(3) = 12.2, P < 0.001). It was significantly greater in the severe neuropathic group than in control subjects (P < 0.003) and in the mild (P < 0.004) and moderate (P < 0.01) neuropathic groups. TC did not correlate significantly with the age (r = -0.003, P > 0.05), duration of diabetes (r = -0.219, P > 0.05), or hemoglobin A1c (HbA1c; r = 0.155, P > 0.05) of diabetic patients. CONCLUSIONS: Corneal confocal microscopy allows rapid, noninvasive in vivo evaluation of corneal nerve tortuosity. This morphologic abnormality relates to the severity of somatic neuropathy and may reflect an alteration in the degree of degeneration and regeneration in diabetes.     

Cogan's syndrome: ocular findings in an atypical case

Cogan's syndrome is an unusual multisystemic disease characterized by interstitial keratitis in association with vestibuloauditory dysfunction and possible irreversible deafness, classified into 2 clinical types: typical and atypical. There is disagreement in the literature about corneal disease in the atypical variety. A 32-year-old woman complaining of ocular hyperemia and ocular pain, photophobia and visual acuity loss in the right eye associated with sudden left hearing loss, vomiting, diarrhea, oliguria, oropharynx pain and fever. Previous history of similar disease in left eye and right hearing. There was intense conjunctival hyperemia, nodular scleritis, episcleritis, and circular infiltrates in the corneal stroma. The patient received pulse-therapy with methylprednisolone and cyclophosphamide. She exhibited significant ocular improvement but poor hearing results. The reported case may be a typical Cogan's syndrome (according to authors that assert the non-existence of corneal disease in the atypical type) with some findings characteristic of the atypical type or an atypical Cogan's syndrome (for those asserting that it is a corneal disease). Differential diagnosis is also discussed.     

角膜神经性疼痛诊治进展

角膜神经性疼痛是一种定义不明的疾病。针对角膜神经性疼痛患者的临床建议、检测方法和治疗方法十分缺乏。目前基于对神经性疼痛病理生理学上的研究,临床上已有一些可行的检测方法和治疗方法,其中检测方法包括使用活性染料的裂隙灯检查法、触觉测量计、丙美卡因挑战测试法、体内共焦距显微镜检测。治疗方法包括抗炎症疗法、神经再生性疗法、系统用药、使用保护性隐形眼镜和一些辅助疗法。本文旨在总结针对其可行的检测方法和治疗方法。     

Arthrogryposis multiplex congenita: a report of two cases

Arthrogryposis multiplex congenita refers to a group of birth defects characterised by multiple joint contractures. The syndrome is caused by neuropathic disease, myopathic disease, or any other cause of decreased fetal joint mobility. Multiple and usually symmetric joint abnormalities with associated muscular and soft tissue hypoplasia are noted at birth. A variety of associated congenital anomalies affecting many organ systems are frequently found. Ocular and orbital findings have been described in patients with arthrogryposis but corneal disease has only rarely been reported. We present corneal findings in two patients with arthrogryposis and discuss the implications for disease pathogenesis. Previous ophthalmologic reports are also reviewed.