Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Prog Retin Eye Res. 2020 May;76:100826. doi: 10.1016/j.preteyeres.2019.100826. Epub 2019 Dec 28.
Known to occur in widespread outbreaks, epidemic keratoconjunctivitis (EKC) is a severe ocular surface infection with a strong historical association with human adenovirus (HAdV). While the conjunctival manifestations can vary from mild follicular conjunctivitis to hyper-acute, exudative conjunctivitis with formation of conjunctival membranes, EKC is distinct as the only form of adenovirus conjunctivitis in which the cornea is also involved, likely due to the specific corneal epithelial tropism of its causative viral agents. The initial development of a punctate or geographic epithelial keratitis may herald the later formation of stromal keratitis, and manifest as subepithelial infiltrates which often persist or recur for months to years after the acute infection has resolved. The chronic keratitis in EKC is associated with foreign body sensation, photophobia, glare, and reduced vision. However, over a century since the first clinical descriptions of EKC, and over 60 years since the first causative agent, human adenovirus type 8, was identified, our understanding of this disorder remains limited. This is underscored by a current lack of effective diagnostic tools and treatments. In part, stasis in our knowledge base has been encouraged by the continued acceptance, and indeed propagation of, inaccurate paradigms pertaining to disease etiology and pathogenesis, particularly with regard to mechanisms of innate and adaptive immunity within the cornea. Owing to its often persistent and medically refractory visual sequelae, reconsideration of key aspects of EKC disease biology is warranted to identify new treatment targets to curb its worldwide socioeconomic burden.
已知广泛暴发的流行性感 染性角膜结膜炎（EKC）是一种严重的眼表感染，与人类腺病毒（HAdV）有着密切的历史关联。虽然结膜表现从轻度滤泡性结膜炎到超急性、渗出性结膜炎伴结膜膜形成各不相同，但 EKC 是唯一一种角膜也受累的腺病毒结膜炎，这可能是由于其致病病毒对角膜上皮的特殊嗜性。点状或地图状上皮角膜炎的最初发展可能预示着随后发生基质角膜炎，并表现为上皮下浸润，在急性感染消退后数月至数年仍持续或复发。EKC 的慢性角膜炎与异物感、畏光、眩光和视力下降有关。然而，自首次临床描述 EKC 以来已经过去了一个多世纪，自首次确定致病因子人类腺病毒 8 型以来也已经过去了 60 多年，我们对这种疾病的认识仍然有限。这突出表现在目前缺乏有效的诊断工具和治疗方法。在某种程度上，我们的知识库进展缓慢，这是因为人们一直接受甚至传播有关疾病病因和发病机制的不准确模式，特别是在角膜固有和适应性免疫机制方面。由于其常持续存在且治疗效果不佳的视觉后遗症，有必要重新考虑 EKC 疾病生物学的关键方面，以确定新的治疗靶点来遏制其在全球范围内的社会经济负担。
