Ward Keith W
Global Preclinical Development, Bausch & Lomb, Rochester, New York 14603, USA.
Optom Vis Sci. 2008 Jan;85(1):8-16. doi: 10.1097/OPX.0b013e31815ed756.
The precise mechanisms controlling the depth and extent of fluorescence signal associated with superficial punctate corneal staining remain unclear. Despite this scientific uncertainty, within the past decade there has been a shift in both medical marketing materials and in the peer-reviewed literature to attempt to extrapolate an observation of superficial punctate fluorescence to suggest compromised corneal integrity. This review presents a survey of the peer-reviewed scientific literature around superficial punctate corneal fluorescein staining.
A comprehensive literature search was conducted for peer-reviewed manuscripts including data around corneal staining, and the results from this search synthesized. A brief historical review of the use of fluorescein dye as a diagnostic tool is provided. A detailed evaluation is made of the evidence supporting or refuting various proposed mechanisms for punctate corneal fluorescein staining, and the implications for corneal health and disease. Finally, future research directions in this field are proposed.
This review highlights major challenges in attempting to extrapolate from the clear importance of gross corneal staining down to the meaning of observation of superficial punctate staining, and should promote greater circumspection in interpreting this phenomenon. The literature reflects that superficial punctate corneal staining does not reflect corneal injury or toxicity. More work is required to elucidate the various mechanisms underlying superficial punctate staining, and to provide clinicians with a rational interpretation algorithm for this observation.
控制与浅层点状角膜染色相关的荧光信号深度和范围的精确机制仍不清楚。尽管存在这种科学上的不确定性，但在过去十年中，医学营销材料和同行评审文献中都出现了一种转变，即试图从浅层点状荧光的观察结果推断角膜完整性受损。本综述对围绕浅层点状角膜荧光素染色的同行评审科学文献进行了调查。
对同行评审的手稿进行了全面的文献检索，包括有关角膜染色的数据，并对检索结果进行了综合。提供了荧光素染料作为诊断工具使用的简要历史回顾。对支持或反驳点状角膜荧光素染色各种提出机制的证据以及对角膜健康和疾病的影响进行了详细评估。最后，提出了该领域未来的研究方向。
本综述强调了试图从明显重要的角膜大体染色推断到浅层点状染色观察结果的意义时所面临的主要挑战，并应促使在解释这一现象时更加谨慎。文献表明，浅层点状角膜染色并不反映角膜损伤或毒性。需要开展更多工作来阐明浅层点状染色背后的各种机制，并为临床医生提供针对这一观察结果的合理解释算法。
