Treatment of Non-Infectious Corneal Injury: Review of Diagnostic Agents, Therapeutic Medications, and Future Targets.
Treatment of Non-Infectious Corneal Injury: Review of Diagnostic Agents, Therapeutic Medications, and Future Targets.
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DOI：
10.1007/s40265-021-01660-5
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发表时间：
2022-03
期刊：
影响因子：
11.5
通讯作者：
Karamichos D
中科院分区：
文献类型：
--
作者：
Dang DH;Riaz KM;Karamichos D
角膜损伤可继发于创伤、化学、炎症、代谢、自身免疫和医源性原因。眼部感染可能经常发生并发角膜损伤，但是，抗菌药物被排除在本审查。虽然医生可能主要依靠临床检查技术来评估这些损伤，但几种药理学试剂，如荧光素，丽丝胺绿色和玫瑰红，可用于制定诊断和制定有效的治疗策略。医生可以从几种止痛药物中选择，以帮助患者舒适，而不会有进一步受伤或延迟眼睛愈合的风险。阿托品、环喷托酯、东莨菪碱和后马托品是最常用于此目的的药物。可明智地使用额外的局部镇痛剂，以增加患者舒适度，从而有助于诊断。甾体抗炎药经常用作治疗方案的一部分。讨论了各种常用药物，包括醋酸泼尼松龙、氯替泼诺、二氟泼尼酯、地塞米松、氟米龙和甲泼尼龙。虽然这些药物对控制眼部炎症有效，但副作用，如眼内压升高和白内障形成，必须由临床医生监测。非甾体类药物，如酮咯酸、溴芬酸、奈帕芬酸和双氯芬酸，由于其在控制眼部炎症方面的功效而额外使用，而不会引起用类固醇观察到的副作用。然而，这些药物有各自的副作用，临床医生需要密切监测。此外，眼科医生通常以标签外的方式使用几种药物来补充控制炎症和治疗角膜损伤。角膜损伤患者常伴有明显的眼表疾病，可能是并发症，也可能是原有疾病的加重。还发现用于管理眼表疾病的几种药剂可用作治疗角膜损伤的治疗设备的一部分。例如，几种抗生素，如多西环素和大环内酯类，已被用于对急性损伤期间上调的特定细胞因子的抗炎作用。最近，人们对羊膜疗法（AMT）产生了浓厚的兴趣，包括局部、冷冻保存和脱水变体。由于AMT能够促进角膜上皮的再上皮化，因此其在具有破坏角膜表面完整性的眼损伤中特别有效。在小病例系列中还探索了基于血液的治疗，包括自体血清泪液、血浆富集生长因子滴眼液和自体血滴，以确定其在挑战性和非挑战性病例中的有效性。保护眼表也是治疗角膜损伤的重要组成部分。临时的保护方法，如绷带隐形眼镜和眼睑的机械闭合（睑板缝合术）在选择性病例中特别有用。胶水疗法，包括生物和非生物变体，也可用于严重损伤和角膜穿孔风险的病例。最后，有多种最近引入和开发中的药物可用作挑战患者人群的辅助治疗。神经营养性角膜疾病可能是严重或慢性损伤的结果。在这种情况下，重组人神经生长因子（cenegermin），局部胰岛素和其他几种新型药物可能是临床医生考虑的替代和有效的选择。
Corneal injuries can occur secondary to traumatic, chemical, inflammatory, metabolic, autoimmune, and iatrogenic causes. Ocular infection may frequently occur concurrent to corneal injury; however, antimicrobial agents are excluded from this present review. While practitioners may primarily rely on clinical examination techniques to assess these injuries, several pharmacological agents, such as fluorescein, lissamine green, and rose bengal, can be used to formulate a diagnosis and develop effective treatment strategies. Practitioners may choose from several analgesic medications to help with patient comfort without risking further injury or delaying ocular healing. Atropine, cyclopentolate, scopolamine, and homatropine are among the most frequently used medications for this purpose. Additional topical analgesic agents may be used judiciously to augment patient comfort to facilitate diagnosis. Steroidal anti-inflammatory agents are frequently used as part of the therapeutic regimen. A variety of commonly used agents, including prednisolone acetate, loteprednol, difluprednate, dexamethasone, fluorometholone, and methylprednisolone are discussed. While these medications are effective for controlling ocular inflammation, side effects, such as elevated intraocular pressure and cataract formation, must be monitored by clinicians. Non-steroidal medications, such as ketorolac, bromfenac, nepafenac, and diclofenac, are additionally used for their efficacy in controlling ocular inflammation without incurring side effects seen with steroids. However, these agents have their own respective side effects, warranting close monitoring by clinicians. Additionally, ophthalmologists routinely employ several agents in an off-label manner for supplementary control of inflammation and treatment of corneal injuries. Patients with corneal injuries not infrequently have significant ocular surface disease, either as a concurrent pathology or as an exacerbation of previously existing disease. Several agents used in the management of ocular surface disease have also been found to be useful as part of the therapeutic armamentarium for treatment of corneal injuries. For example, several antibiotics, such as doxycycline and macrolides, have been used for their anti-inflammatory effects on specific cytokines that are upregulated during acute injuries. There has been a recent wave of interest in amniotic membrane therapies (AMTs), including topical, cryopreserved and dehydrated variants. AMT is particularly effective in ocular injuries with violation of corneal surface integrity due to its ability to promote re-epithelialization of the corneal epithelium. Blood-based therapies, including autologous serum tears, plasma-enriched growth factor eyedrops and autologous blood drops, have additionally been explored in small case series for effectiveness in challenging and recalcitrant cases. Protection of the ocular surface is also a vital component in the treatment of corneal injuries. Temporary protective methods, such as bandage contact lenses and mechanical closure of the eyelids (tarsorrhaphy) can be particularly helpful in selective cases. Glue therapies, including biologic and non-biologic variants, can also be used in cases of severe injury and risk of corneal perforation. Finally, there are a variety of recently introduced and in-development agents that may be used as adjuvant therapies in challenging patient populations. Neurotrophic corneal disease may occur as a result of severe or chronic injury. In such cases, recombinant human nerve growth factor (cenegermin), topical insulin, and several other novel agents may be an alternate and effective option for clinicians to consider.
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DOI：
10.7759/cureus.11724
发表时间：
2020-11-27
期刊：
Cureus
影响因子：
--
作者：
Ahuja AS;Bowden FW 3rd;Robben JL
通讯作者：
Robben JL
影响因子：
6.4
作者：
Bhatia, Subir Singh
通讯作者：
Bhatia, Subir Singh
影响因子：
3.4
作者：
Anitua, E.;Muruzabal, F.;Orive, G.
通讯作者：
Orive, G.
影响因子：
13.7
作者：
Bonini, Stefano;Lambiase, Alessandro;Mantelli, Flavio
通讯作者：
Mantelli, Flavio
影响因子：
2.8
作者：
Balal, Shafi;Nitiahpapand, Rynda;Sharma, Anant
通讯作者：
Sharma, Anant