Inflammatory diseases of the peripheral cornea.
Inflammatory diseases of the peripheral cornea.
复制标题
DOI：
10.1016/s0161-6420(88)33164-7
复制
发表时间：
1988-04
期刊：
影响因子：
13.7
通讯作者：
B. Mondino
中科院分区：
文献类型：
--
作者：
B. Mondino
周边角膜和中央角膜之间存在免疫学差异。周围的角膜更靠近结膜，结膜具有产生免疫反应所需的所有免疫机制。周边角膜较中央角膜具有更多的朗格汉斯细胞和IgM。外周角膜也比中央角膜有更多的补体识别单位C1，因此抗原-抗体复合体，无论是在角膜本身形成的，还是来自泪液、房水或角膜缘血管，都可能比中央角膜更有效地激活补体。涉及周边角膜的自身免疫性疾病包括穆伦氏溃疡和胶原血管疾病。体液和细胞介导的自身免疫现象与穆伦氏溃疡及其对免疫抑制治疗的反应有关，表明它是一种针对角膜本身的自身免疫性疾病。胶原血管疾病可能与伴有或不伴有巩膜炎的外周角膜溃疡有关。在这些疾病中，循环免疫复合体可能滞留在角膜缘血管系统中，导致免疫性血管炎或沉积在角膜周围，引发补体级联。外周角膜疾病可能表现为对外源性抗原的超敏反应，包括卡他性浸润物、溃疡和静脉曲张。在今天的美国，这些角膜损伤通常与葡萄球菌性眼缘炎有关。实验模型表明，对金黄色葡萄球菌细胞壁抗原的超敏反应可能在其免疫发病机制中起重要作用。
Immunologic differences exist between the peripheral and central cornea. The peripheral cornea is closer to the conjunctiva, which has all of the immunologic machinery necessary to generate an immune response. The peripheral cornea has more Langerhans' cells and IgM than the central cornea. The peripheral cornea also has more C1, the recognition unit of the classic pathway of complement, than the central cornea so that antigen-antibody complexes, whether formed in the cornea itself or whether derived from the tears, aqueous humor, or limbal vessels, may activate complement more effectively in the peripheral than central cornea. Autoimmune diseases that involve the peripheral cornea include Mooren's ulcer and collagen vascular diseases. The humoral- and cell-mediated autoimmune phenomena that are associated with Mooren's ulcer and its response to immunosuppressive therapy suggest that it is an autoimmune disease directed against the cornea itself. Collagen vascular diseases may be associated with peripheral corneal ulcers with or without scleritis. In these diseases, circulating immune complexes may lodge in the limbal vasculature causing an immune vasculitis or deposit in the peripheral cornea setting off the complement cascade. Peripheral corneal diseases that probably represent a hypersensitivity reaction to exogenous antigens include catarrhal infiltrates and ulcers and phlyctenules. In the United States today, these corneal lesions are generally associated with staphylococcal blepharitis. Experimental models suggest that hypersensitivity toStaphylococcus aureuscell wall antigens may be important to their immunopathogenesis.