Yagci Ayse
Ege University, School of Medicine, Department of Ophthalmology, Izmir, Turkey.
Clin Ophthalmol. 2012;6:747-54. doi: 10.2147/OPTH.S24947. Epub 2012 May 14.
Ulcerative inflammation of the cornea occurs in the perilimbal cornea, and is associated with autoimmune collagen vascular and arthritic diseases. Rheumatoid arthritis is the most frequent underlying disease. The tendency for peripheral location is due to the distinct morphologic and immunologic characteristics of the limbal conjunctiva, which provides access for circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates immune-mediated vasculitis, and causes inflammatory cell and protein leakage due to vessel wall damage. Development of peripheral ulcerative keratitis associated with systemic disease may represent worsening of a potentially life-threatening disease. Accompanying scleritis, particularly the necrotizing form, is usually observed in severe cases, which may result in corneal perforation and loss of vision. Although first-line treatment with systemic corticosteroids is indicated for acute phases, immunosuppressive and cytotoxic agents are required for treatment of peripheral ulcerative keratitis associated with multisystem disorders. Recently, infliximab, a chimeric antibody against proinflammatory cytokine tumor necrosis factor-alpha, was reported to be effective in cases refractory to conventional immunomodulatory therapy. The potential side effects of these therapies require close follow-up and regular laboratory surveillance.
角膜溃疡性炎症发生于角膜缘周围，与自身免疫性胶原血管疾病和关节炎相关。类风湿性关节炎是最常见的基础疾病。其周边定位倾向归因于角膜缘结膜独特的形态学和免疫学特征，这使得循环免疫复合物能够通过毛细血管网络进入周边角膜。免疫复合物在角膜缘血管末端的沉积引发免疫介导的血管炎，并由于血管壁损伤导致炎症细胞和蛋白质渗漏。与全身性疾病相关的周边溃疡性角膜炎的发展可能代表一种潜在危及生命疾病的恶化。严重病例通常会伴有巩膜炎，尤其是坏死性巩膜炎，这可能导致角膜穿孔和视力丧失。虽然急性期需用全身性皮质类固醇进行一线治疗，但对于与多系统疾病相关的周边溃疡性角膜炎的治疗，需要使用免疫抑制剂和细胞毒性药物。最近，英夫利昔单抗，一种针对促炎细胞因子肿瘤坏死因子-α的嵌合抗体，据报道在对传统免疫调节治疗难治的病例中有效。这些治疗的潜在副作用需要密切随访和定期实验室监测。
