Pérez-Bartolomé F, Mingo Botín D, de Dompablo E, de Arriba P, Arnalich Montiel F, Muñoz Negrete F J
Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España.
Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España.
Arch Soc Esp Oftalmol (Engl Ed). 2019 Apr;94(4):171-183. doi: 10.1016/j.oftal.2019.01.002. Epub 2019 Feb 2.
Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage of trigeminal innervation. This leads to epithelial defects, ulceration and, eventually, perforation. Both herpes simplex and varicella zoster keratitis are reported to be the main causes of NK. Furthermore, prognosis in this type of NK is poor. Classic clinical findings in post-herpes NK are spontaneous epithelial breakdown, round and central epithelial defects with smooth edges, stromal melting and thinning, scarring, and neovascularisation. Although several medical and surgical treatments have been reported, no therapies are currently available to definitely restore corneal sensitivity. Therefore, NK remains a challenging disease to treat. In this review a summary is presented of the pathogenesis, manifestations, and current management of post-herpes NK. The role of antiviral treatment and varicella-zoster vaccination is also discussed. A description is also presented on both medical and surgical novel therapies, such as regenerative drugs and corneal neurotization.
神经营养性角膜病变（NK）是一种由三叉神经支配受损引起的角膜退行性疾病。这会导致上皮缺损、溃疡，最终穿孔。据报道，单纯疱疹性角膜炎和水痘带状疱疹性角膜炎都是NK的主要病因。此外，这种类型的NK预后较差。疱疹后NK的典型临床特征是自发性上皮破损、边缘光滑的圆形中央上皮缺损、基质溶解和变薄、瘢痕形成以及新生血管形成。尽管已经报道了几种药物和手术治疗方法，但目前尚无明确恢复角膜敏感性的疗法。因此，NK仍然是一种具有挑战性的疾病。本文综述了疱疹后NK的发病机制、临床表现和当前治疗方法。还讨论了抗病毒治疗和水痘带状疱疹疫苗接种的作用。同时也介绍了药物和手术新疗法，如再生药物和角膜神经化。
