中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (26): 5713-5720.doi: 10.12307/2025.718

• 组织构建综述 tissue construction review • 上一篇    

免疫性周边溃疡性角膜炎：系统免疫调节联合手术治疗的可行性

刘晓涵1，陈颖欣2，高明宏2   

  1. 1大连医科大学研究生院，辽宁省大连市  116000；2中国人民解放军北部战区总医院，辽宁省沈阳市  110000
  • 收稿日期:2024-08-14 接受日期:2024-10-16 出版日期:2025-09-18 发布日期:2025-02-28
  • 通讯作者: 陈颖欣，博士，博士后，副主任医师，中国人民解放军北部战区总医院，辽宁省沈阳市 110000
  • 作者简介:刘晓涵，女，1998年生，辽宁省沈阳市人，汉族，大连医科大学2022级在读硕士，主要从事角膜病学研究。 并列第一作者：高明宏，男，1963年生，辽宁省沈阳市人，汉族，博士，主任医师，主要从事角膜病学研究。

Immune-associated peripheral ulcerative keratitis: feasibility of systemic immunomodulation combined with surgical treatment

Liu Xiaohan1, Chen Yingxin2, Gao Minghong2   

  1. 1Graduate School of Dalain Medical University, Dalian 116000, Liaoning Province, China; 2General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China 
  • Received:2024-08-14 Accepted:2024-10-16 Online:2025-09-18 Published:2025-02-28
  • Contact: Chen Yingxin, MD, Associate chief physician, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
  • About author:Liu Xiaohan, Master’s candidate, Dalain Medical University, Dalian 116000, Liaoning Province, China Gao Minghong, MD, Chief physician, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China Liu Xiaohan and Gao Minghong contributed equally to this work.

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摘要：


文题释义：
角膜缘：为角膜同巩膜之间的一条灰白色过渡带，是角膜与巩膜的移行区，具有角膜、结膜、巩膜外膜和巩膜的特征，表面不光滑，有很多放射状突起，自巩膜开始，到角膜逐渐消失，特点是没有前弹力层，后弹力层变为梳状韧带。角膜缘有血管和淋巴管，常有色素沉着。
周边溃疡性角膜炎：是一种发生在角膜缘处的具有破坏性的炎症性疾病，病理特征是免疫细胞侵入角膜缘，角膜上皮出现新月形缺损、基质变薄和炎症细胞浸润。周边溃疡性角膜炎的病理生理机制通常与免疫复合物在角膜缘处血管沉积并产生微血管炎相关。 

背景：免疫性周边溃疡性角膜炎如果未及时发现及治疗，会导致角膜变薄、溃疡甚至穿孔，进而引起患者视力受损，影响生活质量。
目的：讨论免疫性周边溃疡性角膜炎的发病机制，总结该疾病的最新诊疗方法。
方法：以“Peripheral Ulcerative Keratitis，immunity，Immune system disease，pathogenesis，immunomodulatory therapy，surgical treatment，keratoplasty”为英文检索词，以“边缘性角膜溃疡，免疫，免疫系统疾病，发病机制，系统免疫调节治疗，手术治疗，角膜移植手术”为中文检索词，检索中国知网、万方数据库、EI数据库和 PubMed 数据库建库至2024年10月期间的相关文献，最终纳入68篇文献对免疫性周边溃疡性角膜炎目前的研究进展进行全面阐述。
结果与结论：免疫性周边溃疡性角膜炎包括蚕食性角膜溃疡、睑缘炎相关角膜结膜病、上方角膜缘角结膜炎和自身免疫性疾病相关的周边溃疡性角膜炎。由于角膜缘的生理学特性，周边溃疡性角膜炎通常与免疫反应有关，其病理生理学机制通常与免疫复合物在角膜缘处血管沉积并产生微血管炎相关。无论在免疫性周边溃疡性角膜炎发病前是否确诊自身免疫性疾病，均应全身使用系统免疫调节治疗，这有助于减少与全身炎症相关的眼部并发症。非手术治疗如系统免疫调节治疗有利于眼部症状的缓解，当非手术治疗无效或病变浸润角膜深度达后弹力层时会引起角膜穿孔，联合手术治疗有助于保持眼球结构的完整性，但系统免疫调节联合手术治疗在免疫性周边溃疡性角膜炎的疾病发展中尚无明确的治疗指南。
https://orcid.org/0009-0005-3681-4967(刘晓涵)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 边缘性角膜溃疡, 发病机制, 自身免疫性疾病, 角膜缘, 系统免疫调节治疗, 角膜移植手术, 板层角膜移植术, 脱细胞角膜基质, 工程化组织构建

Abstract: BACKGROUND: If not detected and treated in a timely manner, immune-associated peripheral ulcerative keratitis can lead to corneal thinning, ulcers and even perforation, thereby causing visual loss and affecting the patient’s quality of life. 
OBJECTIVE: To discuss the pathogenesis of immune-associated peripheral ulcerative keratitis and summarize the diagnosis and treatment ideas and the latest treatment methods for this disease.
METHODS: Search terms were “peripheral ulcerative keratitis, immunity, immune system disease, pathogenesis, immunomodulatory therapy, surgical treatment, keratoplasty” in English and Chinese. Relevant literature on peripheral ulcerative keratitis published from database inception to October 2024 was searched by computer in CNKI, WanFang, PubMed, and EI databases. A total of 68 papers were ultimately selected to comprehensively describe the new research progress in the research on immune-associated peripheral ulcerative keratitis.
RESULTS AND CONCLUSION: Immune-associated peripheral ulcerative keratitis includes Mooren’s ulcer, blepharokeratoconjunctivitis, superior limbic keratoconjunctivitis, and autoimmune related peripheral ulcerative keratitis. Due to the physiology of the corneal limbus, peripheral ulcerative keratitis is usually associated with an immune response, and the pathophysiologic mechanism is usually related to the deposition of immune complexes in the blood vessels at the limbus and the production of microangiitis. Systemic immunomodulatory therapy should be used whether or not an autoimmune disease is diagnosed prior to the onset of immune-associated peripheral ulcerative keratitis, which can help to reduce ocular complications associated with systemic inflammation. Nonsurgical treatment, such as immunomodulatory therapy, is beneficial for relieving ocular symptoms, but when nonsurgical treatment is ineffective or the lesion infiltrates the Descemet membrane, it can cause corneal perforation. Combined surgical treatment can help maintain the structural integrity of the eyeball. However, there is no clear evidence for the combination of immunomodulatory therapy and surgical treatment in the development of immune-associated Peripheral ulcerative keratitis. This article reviews the literature on the diagnosis and treatment of immune-associated peripheral ulcerative keratitiss.

Key words: peripheral ulcerative keratitis, pathogenesis, systemic autoimmune diseases, limbus, immunomodulatory therapy, keratoplasty, lamellar keratoplasty, acellular porcine corneal stroma, engineered tissue construction

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