Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico.
Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, USA.
Surv Ophthalmol. 2023 Jul-Aug;68(4):713-727. doi: 10.1016/j.survophthal.2023.02.009. Epub 2023 Mar 5.
The cornea is a densely innervated avascular tissue showing exceptional inflammatory and immune responses. The cornea is a site of lymphangiogenic and angiogenic privilege devoid of blood and lymphatic vessels that limits the entry of inflammatory cells from the adjacent and highly immunoreactive conjunctiva. Immunological and anatomical differences between the central and peripheral cornea are also necessary to sustain passive immune privilege. The lower density of antigen-presenting cells in the central cornea and the 5:1 peripheral-to-central corneal ratio of C1 are two main features conferring passive immune privilege. C1 activates the complement system by antigen-antibody complexes more effectively in the peripheral cornea and, thus, protects the central corneas' transparency from immune-driven and inflammatory reactions. Wessely rings, also known as corneal immune rings, are noninfectious ring-shaped stromal infiltrates usually formed in the peripheral cornea. They result from a hypersensitivity reaction to foreign antigens, including those of microorganism origin. Thus, they are thought to be composed of inflammatory cells and antigen-antibody complexes. Corneal immune rings have been associated with various infectious and noninfectious causes, including foreign bodies, contact lens wear, refractive procedures, and drugs. We describe the anatomical and immunologic basis underlying Wessely ring formation, its causes, clinical presentation, and management.
角膜是一种密集神经支配的无血管组织，表现出异常的炎症和免疫反应。角膜是淋巴管生成和血管生成特权的部位，没有血管和淋巴管，限制了来自相邻且高度免疫反应性的结膜的炎症细胞进入。中央角膜和周边角膜之间的免疫学和解剖学差异也是维持被动免疫特权所必需的。中央角膜中抗原呈递细胞的密度较低，C1 的周边到中央角膜比为 5:1，这是赋予被动免疫特权的两个主要特征。C1 通过抗原抗体复合物在周边角膜更有效地激活补体系统，从而保护中央角膜的透明性免受免疫驱动和炎症反应的影响。韦斯利环，也称为角膜免疫环，是通常在周边角膜形成的非传染性环形基质浸润。它们是对外源抗原（包括微生物来源的抗原）的过敏反应的结果。因此，它们被认为是由炎症细胞和抗原抗体复合物组成的。角膜免疫环与各种感染和非感染性原因有关，包括异物、隐形眼镜佩戴、屈光手术和药物。我们描述了韦斯利环形成的解剖学和免疫学基础、其病因、临床表现和治疗。
