上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2022 , Vol. 42 >Issue 4: 528 - 534

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.04.016

综述

角膜知觉重建的分类与研究进展

  • 吴越 ,
  • 张嘉莹 ,
  • 王炜 ,
  • 李瑾
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  • 1.上海交通大学医学院附属第九人民医院眼科，上海 200011
    2.上海市眼眶病眼肿瘤重点实验室，上海 200011
    3.上海交通大学医学院附属第九人民医院整复外科，上海 200011
吴 越（1995—），女，博士生；电子信箱：15800762292@163.com。
王 炜，电子信箱：13818054492@163.com。
李 瑾，电子信箱：abcd1971206@126.com

收稿日期: 2021-10-26

  录用日期: 2022-04-19

  网络出版日期: 2022-04-28

基金资助

国家自然科学基金(81870688);上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ201818)

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Classification and research progress of corneal neurotization

  • Yue WU ,
  • Jiaying ZHANG ,
  • Wei WANG ,
  • Jin LI
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  • 1.Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    2.Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
    3.Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
WANG Wei, E-mail: 13818054492@163.com.
LI Jin, E-mail: abcd1971206@126.com

Received date: 2021-10-26

  Accepted date: 2022-04-19

  Online published: 2022-04-28

Supported by

National Natural Science Foundation of China(81870688);Clinical Research Program of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ201818)

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摘要

角膜神经来自三叉神经眼支，主要支配角膜的知觉。三叉神经至眼表的任一节段受损，均有可能导致角膜神经损伤，并可引起角膜知觉减退或缺失。神经营养不良性角膜病变即是因三叉神经损伤继而角膜神经的感觉及营养功能受损所致，主要表现为角膜知觉下降或缺失，并可导致角膜上皮缺损、溃疡或者穿孔。然而，神经营养不良性角膜病变发病早期多仅表现为角膜知觉的轻度下降及泪膜的不稳定，因此在临床上较为隐匿；同时，关于促进角膜神经的修复与再生、恢复角膜知觉的临床处理方法通常也较为单一。目前，药物治疗、非手术干预、手术重建是治疗神经营养不良性角膜病变从而促进角膜神经及知觉恢复的治疗方法。其中，药物治疗的主要目的为抗感染及抗炎，同时维持眼表环境稳定，防止角膜进一步损伤。目前，一些新型生物制剂也正在研发及临床试验中，包括富血小板血浆、自体血清及重组人神经生长因子等。非手术干预的主要目的即减少角膜暴露以保护角膜，通常包含治疗性接触镜及医用胶带、肉毒素注射等多种使眼睑下垂遮盖角膜的治疗方式。关于手术重建，除了常规的各类以修复角膜缺损、减少暴露面积为目的的传统术式之外，还包括角膜神经移植术这一定位于改善角膜知觉及角膜神经支配的新术式，其对于由于三叉神经损伤导致角膜上皮下神经纤维缺失的患者来说，是一种较为理想的手术方式。药物治疗、非手术干预、手术重建在临床应用中并不是割裂的。该文总结了以上3类治疗手段的应用进展，以期为未来临床上根据疾病发展的进程及不同的严重程度选择合适的治疗方式、实现角膜知觉的综合性重建提供参考。

关键词： 角膜营养不良; 三叉神经疾病; 神经移植; 神经再生

本文引用格式

吴越 , 张嘉莹 , 王炜 , 李瑾 . 角膜知觉重建的分类与研究进展[J]. 上海交通大学学报（医学版）, 2022 , 42(4) : 528 -534 . DOI: 10.3969/j.issn.1674-8115.2022.04.016

Abstract

The corneal nerve originates from the trigeminal nerve, which mainly innervates the corneal sensation. Therefore, corneal nerve injury and decrease of corneal sensation occur when the trigeminal nerve is damaged. Neurotrophic keratopathy (NK) is a disease related with alterations in corneal nerves, leading to corneal epithelial defects, ulcer and perforation. However, mild NK is mostly manifested as a slight decrease in corneal sensation and instability of the tear film, so it is quite insidious in clinical practice. At the same time, the clinical treatment methods for promoting corneal reinnervation and restoring corneal sensation are usually relatively simple. Currently, medical treatment, non-surgical interventions and surgical interventions are the treatments for NK thus promoting corneal nerve and sensation recovery. In addition to maintaining the stability of the ocular surface, the main purpose of medical treatment is anti-infection and anti-inflammation, and to prevent further damage to the cornea. Novel biological agents are also under clinical trials such as platelet-rich plasma, autologous serum and recombinant human nerve growth factor. Non-surgical intervention which mainly includes therapeutic contact lenses, medical tape and botulinum toxin injections aims to reduce corneal exposure and protect the cornea. With regard to surgical interventions, in addition to the conventional procedures aimed at repairing corneal defects and reducing the exposed area, there is also a new procedure called corneal nerve transplantation, which is aimed at improving corneal sensation and corneal innervation. Corneal nerve transplantation is a new surgical method that is directly targeted at improving corneal sensation and innervation. It is an ideal surgical method for patients with loss of corneal subbasal nerve fibers due to trigeminal nerve injury. In conclusion, medical treatment, non-surgical intervention and surgical neurotization are not separated in clinical practice. This article summarizes the progress of the application of the above three types of treatments in order to provide a reference for the future clinical selection of appropriate treatment modalities and comprehensive reconstruction of corneal sensation according to the course and different severity of disease development.

Key words： corneal dystrophy; trigeminal nerve disease; nerve transplantation; nerve regeneration

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