Hazlett L, Suvas Susmit, McClellan Sharon, Ekanayaka Sandamali
Expert Rev Ophthalmol. 2016;11(4):285-297. doi: 10.1080/17469899.2016.1203254. Epub 2016 Jun 30.
Ocular infections remain an important cause of blindness worldwide and represent a challenging public health concern. In this regard, microbial keratitis due to fungal, bacterial, or viral infection can result in significant vision loss secondary to corneal scarring or surface irregularity. Left untreated corneal perforation and endophthalmitis can result, leading to loss of the eye. Rigorously studied animal models of disease pathogenesis have provided novel information that suggests new modes of treatment that may be efficacious clinically and emerging clinical data is supportive of some of these discoveries.
This review focuses on advances in our understanding of disease pathogenesis in animal models and clinical studies and how these relate to improved clinical treatment. We also discuss a novel approach to treatment of microbial keratitis due to infection with these bacterial pathogens using PACK-CXL and recommend increased basic and clinical studies to address and refine the efficacy of this procedure.
Because resistance to antibiotics has developed over time to these bacterial pathogens, caution must be exercised in treatment. Attractive novel modes of treatment that hold new promise for further investigation include lipid based therapy, as well as use of small molecules that bind deleterious specific host responsive molecules and use of microRNA based therapies.
眼部感染仍是全球失明的重要原因，是一个具有挑战性的公共卫生问题。在这方面，真菌、细菌或病毒感染引起的微生物性角膜炎可因角膜瘢痕形成或表面不规则而导致严重视力丧失。若不治疗，可导致角膜穿孔和眼内炎，进而导致失明。对疾病发病机制进行的严格动物模型研究提供了新信息，提示了可能在临床上有效的新治疗模式，并且新出现的临床数据也支持其中一些发现。
本综述重点关注我们在动物模型和临床研究中对疾病发病机制的理解进展，以及这些进展与改善临床治疗的关系。我们还讨论了一种使用PACK-CXL治疗这些细菌病原体感染引起的微生物性角膜炎的新方法，并建议增加基础研究和临床研究，以探讨和完善该治疗方法的疗效。
由于这些细菌病原体随时间推移已产生抗生素耐药性，因此在治疗时必须谨慎。具有吸引力且有望进一步研究的新治疗模式包括基于脂质的疗法，以及使用与有害的特定宿主反应性分子结合的小分子和基于微小RNA的疗法。
