疱疹性基质疾病之谜。
The enigma of herpes stromal disease.
作者信息
McGill J
出版信息
Br J Ophthalmol. 1987 Feb;71(2):118-25. doi: 10.1136/bjo.71.2.118.
Herpes stromal disease is due to direct damage as a result of viral replication, virally induced immune mechanisms, or a combination of the two. Viral replication may have a major initiating role in the production of herpes simplex and herpes zoster induced stromal disease, and steroids may initially be harmful in their treatment. On topical antiviral drugs alone, in patients who never previously had had topical steroids, 14 of 15 cases of herpes simplex induced disciform keratitis responded favourably in an average of 44 days of treatment. This compared with one out of 14 responding if steroids had previously been used, 13 of 14 requiring topical steroids and an average 112 days' treatment. In herpes zoster stromal disease cases 78% had epithelial involvement, 54 of 57 responded to topical antivirals alone without the use of steroids, 2% recurred, and treatment averaged a total of 62 days. If steroids were used alone or in combination with antivirals, there was a 50% recurrence rate and 200 day total treatment duration.
疱疹性基质疾病是由病毒复制、病毒诱导的免疫机制或两者共同作用导致的直接损伤引起的。病毒复制可能在单纯疱疹和带状疱疹诱导的基质疾病的发生中起主要启动作用，而类固醇药物在治疗初期可能有害。仅使用局部抗病毒药物治疗时，在从未使用过局部类固醇药物的患者中，15例单纯疱疹性盘状角膜炎患者中有14例在平均44天的治疗后反应良好。相比之下，如果之前使用过类固醇药物，14例患者中只有1例有反应，14例中有13例需要局部使用类固醇药物，平均治疗时间为112天。在带状疱疹基质疾病病例中，78%有上皮受累，57例中有54例仅使用局部抗病毒药物治疗即有反应，无需使用类固醇药物，2%复发，平均治疗时间总计62天。如果单独使用类固醇药物或与抗病毒药物联合使用，复发率为50%，总治疗时间为200天。
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