Albietz Julie, Sanfilippo Paul, Troutbeck Robyn, Lenton Lee M
Centre for Eye Research, Queensland University of Technology, O Blocj, QUT Kelvin Grove, Victoria Park Road, Kelvin Grove 4059, Australia.
Optom Vis Sci. 2003 Jun;80(6):420-30. doi: 10.1097/00006324-200306000-00007.
To review the incidence, underlying pathophysiology, and clinical features of filamentary keratitis and to identify evidence-based best-practice strategies for managing filamentary keratitis.
A comprehensive review of published literature was undertaken. Recommendations for best-practice management strategies were based on the available evidence. Three cases are presented to illustrate the clinical findings and management of patients with chronic filamentary keratitis.
Although the evidence base is limited by the absence of well-designed studies, current evidence indicates the following: (1) Aqueous-deficient dry eye (keratoconjunctivitis sicca) is the most common ocular condition associated with filamentary keratitis. (2) Current best-practice management of filamentary keratitis involves treating the underlying dry eye and specific treatments for the corneal filaments. Proposed treatments include nonpreserved lubricants, topical steroidal and nonsteroidal anti-inflammatory agents, and punctal plugs for aqueous-deficient dry eye as well as mechanical removal of filaments, hypertonic saline, mucolytic agents, and bandage contact lenses for the filaments. (3) Filamentary keratitis can be induced or exacerbated by contact lens wear and ocular surgical procedures such as cataract surgery and corneal graft surgery. Pre- and postoperative ocular surface management strategies should be considered in the surgical planning of patients with, or who are susceptible to, filamentary keratitis. Filamentary keratitis can also be induced and/or exacerbated by chronic use of ocular and/or systemic medications, and alternate medications or additional measures to manage the tear film and ocular surface may be required in these cases.
Filamentary keratitis can be a chronic, recurrent, and debilitating condition. With a systemic approach to diagnosis and management, the condition can be effectively controlled and the incidence and severity of recurrences minimized.
回顾丝状角膜炎的发病率、潜在病理生理学及临床特征，并确定基于证据的丝状角膜炎最佳治疗策略。
对已发表文献进行全面综述。基于现有证据提出最佳治疗策略建议。列举三例以说明慢性丝状角膜炎患者的临床发现及治疗情况。
尽管证据基础因缺乏精心设计的研究而受限，但目前证据表明：（1）泪液缺乏性干眼（角结膜干燥症）是与丝状角膜炎相关的最常见眼部疾病。（2）目前丝状角膜炎的最佳治疗方法包括治疗潜在的干眼及针对角膜丝的特定治疗。建议的治疗方法包括无防腐剂润滑剂、局部甾体和非甾体抗炎药、用于泪液缺乏性干眼的泪小点栓子，以及角膜丝的机械清除、高渗盐水、黏液溶解剂和绷带式隐形眼镜。（3）丝状角膜炎可由隐形眼镜佩戴以及白内障手术和角膜移植手术等眼科手术诱发或加重。对于患有或易患丝状角膜炎的患者，在手术规划中应考虑术前和术后眼表管理策略。慢性使用眼部和/或全身药物也可诱发和/或加重丝状角膜炎，在这些情况下可能需要更换药物或采取额外措施来管理泪膜和眼表。
丝状角膜炎可能是一种慢性、复发性且使人衰弱的疾病。通过系统的诊断和治疗方法，该病可得到有效控制，并使复发的发生率和严重程度降至最低。
