Ramamurthi S, Rahman M Q, Dutton G N, Ramaesh K
Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
Eye (Lond). 2006 Jun;20(6):635-44. doi: 10.1038/sj.eye.6702005. Epub 2005 Jul 15.
Recurrent corneal erosions (RCE) are common. They are characterised by repeated episodes of pain, difficulty in opening the eyes, watering, and photophobia resulting from poor epithelial adhesion. In the majority of patients with RCE, trauma is the initiating factor. Epithelial, stromal, and endothelial corneal dystrophies have all been described in association with RCE. Other causes that may lead to RCE include chemical and thermal injuries, previous herpetic keratitis, meibomian gland dysfunction, ocular rosacea, diabetes mellitus, Salzmann's nodular degeneration, band keratopathy, previous bacterial ulceration, kerato-conjunctivitis sicca, and epidermolysis bullosa. The conditions that are associated with RCE can be either primary or secondary depending on whether the basement membrane complex abnormality is intrinsic or acquired. Primary types tend to be bilateral, symmetrical and develop in multiple corneal locations. The pathogenetic mechanism of this disorder is related to poor adhesion of the corneal epithelium to the underlying stroma. Excessive matrix metalloproteinase (MMP) activity may play a role in the pathogenesis. Although the majority of patients will respond to simple measures such as padding and antibiotic ointment, RCE resistant to simple measures require approaches that are more elaborate. The common goal of these approaches is to encourage proper formation of adhesion complexes between the epithelium and the stroma. The use of long-term contact lenses, autologous serum eye drops, botulinum toxin, induced ptosis, oral MMP inhibitors, diamond burr polishing of Bowman's membrane have been reported with varying degree of success in treating RCE. Anterior stromal puncture with insulin needles or Neodymium : aluminium-yttrium-garnet may enhance the epithelial adhesion to the basement membrane by scar formation and success rates of up to 80% have been reported in the treatment of recalcitrant RCE. Excimer laser photo-therapeutic keratectomy (PTK) is now a well-established treatment modality for RCE and is being used both safely and effectively. Partial ablation of Bowman's layer with PTK gives a smooth surface for the newly generating epithelium to migrate and form adhesion complexes. The pathogenesis, clinical features, and management options of this common disorder are discussed in this review article.
复发性角膜糜烂（RCE）很常见。其特征为因上皮黏附不良导致的反复疼痛、睁眼困难、流泪及畏光发作。在大多数RCE患者中，外伤是起始因素。上皮性、基质性和内皮性角膜营养不良均已被描述与RCE相关。其他可能导致RCE的原因包括化学和热烧伤、既往疱疹性角膜炎、睑板腺功能障碍、眼部酒渣鼻、糖尿病、萨尔茨曼结节状变性、带状角膜病变、既往细菌性溃疡、角结膜干燥症和大疱性表皮松解症。与RCE相关的疾病可分为原发性或继发性，这取决于基底膜复合体异常是先天性的还是后天获得的。原发性类型往往为双侧性、对称性，且在多个角膜部位发病。该疾病的发病机制与角膜上皮与下方基质的黏附不良有关。基质金属蛋白酶（MMP）活性过高可能在发病机制中起作用。尽管大多数患者对诸如眼罩和抗生素眼膏等简单措施有反应，但对简单措施耐药的RCE需要更复杂的治疗方法。这些方法的共同目标是促进上皮与基质之间黏附复合体的正常形成。长期佩戴隐形眼镜、自体血清滴眼液、肉毒杆菌毒素、诱导性上睑下垂、口服MMP抑制剂、用钻石钻磨Bowman膜在治疗RCE方面均有不同程度的成功报道。用胰岛素针或钕：铝钇石榴石进行前基质穿刺可通过瘢痕形成增强上皮与基底膜的黏附，在治疗顽固性RCE中报道的成功率高达80%。准分子激光光治疗性角膜切削术（PTK）现在是一种成熟的RCE治疗方式，且使用安全有效。用PTK部分切除Bowman层可为新生成的上皮迁移并形成黏附复合体提供光滑表面。本文综述了这种常见疾病的发病机制、临床特征和治疗选择。
