Geerling Gerd, Lisch Walter, Finis David
Augenklinik, Universitätsklinikum Düsseldorf.
Augenklinik, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz.
Klin Monbl Augenheilkd. 2018 Jun;235(6):697-701. doi: 10.1055/a-0611-5783. Epub 2018 Jun 12.
The corneal epithelium is the most important structure of the ocular optical system. Recurrent corneal erosions can result from inflammation, trauma, degeneration and dystrophies. Epithelial basement membrane dystrophy (EBMD), epithelial recurrent erosion dystrophy (ERED) and Francheschetti and Meesmann's epithelial corneal dystrophy (MECD) can all - besides other signs and symptoms - result in more or less frequent corneal erosions. The pathomechanisms involved however are different. In EBMD, corneal erosions are facultative and clinical signs are often subtle. Aberrant basement membrane structures are associated with thinning of the epithelium and can be clinically identified as maps or fingerprints. In ERED, recurrent corneal erosions are - predominantly in the first decades of life - always present. A defect in the COL17A1 gene results in a dysfunctional hemidesmosome. In MECD, punctate corneal erosions are less frequent and result from intraepithelial microcysts which open spontaneously onto the ocular surface. Usually lubricants, therapeutic contact lenses and sometimes epithelial debridement and phototherapeutic keratectomy are the mainstay for treating corneal erosions in these three dystrophies.
角膜上皮是眼屈光系统最重要的结构。复发性角膜糜烂可由炎症、外伤、变性和营养不良引起。上皮基底膜营养不良（EBMD）、上皮复发性糜烂营养不良（ERED）以及弗朗切斯科蒂和梅斯曼上皮性角膜营养不良（MECD），除了其他体征和症状外，均可或多或少地导致角膜糜烂频繁发作。然而，它们所涉及的发病机制有所不同。在EBMD中，角膜糜烂是偶发性的，临床体征往往不明显。异常的基底膜结构与上皮变薄有关，在临床上可表现为地图状或指纹状。在ERED中，复发性角膜糜烂在生命的最初几十年中总是存在。COL17A1基因缺陷导致半桥粒功能障碍。在MECD中，点状角膜糜烂较少见，是由上皮内微囊肿自发开口于眼表所致。通常，润滑剂、治疗性隐形眼镜，有时还有上皮清创术和光治疗性角膜切削术是治疗这三种营养不良性角膜糜烂的主要方法。
