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血源滴眼液治疗角膜神经病理性疼痛。

Blood-Derived Eye Drops for the Treatment of Corneal Neuropathic Pain.

机构信息

Department of Ophthalmology, MTI Khyber Teaching Hospital, Peshawar, Pakistan.

Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.

出版信息

J Ocul Pharmacol Ther. 2024 Jun;40(5):281-292. doi: 10.1089/jop.2023.0155. Epub 2024 Apr 22.

Abstract

Blood-derived preparations, including autologous or allogenic serum, umbilical cord serum/plasma, and platelet-rich plasma eye drops, contain various growth factors, cytokines, and immunoglobulins that resemble natural tears. These components play important roles in corneal cell migration, proliferation, and wound healing. Blood-derived eye drops have demonstrated clinical effectiveness across a spectrum of ocular surface conditions, encompassing dry eye disease, Sjögren's syndrome, graft-versus-host disease, and neuropathic corneal pain (NCP). Currently, management of NCP remains challenging. The emergence of blood-derived eye drops represents a promising therapeutic approach. In this review, we discuss the benefits and limitations of different blood-derived eye drops, their mechanisms of action, and treatment efficacy in patients with NCP. Several studies have demonstrated the clinical efficacy of autologous serum eye drops in relieving pain and pain-like symptoms, such as allodynia and photoallodynia. Corneal nerve parameters were also significantly improved, as evidenced by increased nerve fiber density, length, nerve reflectivity, and tortuosity, as well as a decreased occurrence of beading and neuromas after the treatment. The extent of nerve regeneration correlated with improvement in patient-reported photoallodynia. Cord plasma eye drops also show potential for symptom alleviation and corneal nerve regeneration. Future directions for clinical practice and research involve standardizing preparation protocols, establishing treatment guidelines, elucidating underlying mechanisms, conducting long-term clinical trials, and implementing cost-effective measures such as scaling up manufacturing. With ongoing advancements, blood-derived eye drops hold promise as a valuable therapeutic option for patients suffering from NCP.

摘要

血源性制剂,包括自体或同种异体血清、脐带血清/血浆和富含血小板的眼用血浆,含有各种生长因子、细胞因子和免疫球蛋白,类似于天然泪液。这些成分在角膜细胞迁移、增殖和伤口愈合中发挥重要作用。血源性滴眼剂在一系列眼表疾病中具有临床疗效,包括干眼症、干燥综合征、移植物抗宿主病和神经病理性角膜痛(NCP)。目前,NCP 的管理仍然具有挑战性。血源性滴眼剂的出现代表了一种有前途的治疗方法。在这篇综述中,我们讨论了不同血源性滴眼剂的益处和局限性、它们的作用机制以及它们在 NCP 患者中的治疗效果。几项研究表明,自体血清滴眼剂在缓解疼痛和疼痛样症状(如感觉过敏和光过敏)方面具有临床疗效。角膜神经参数也得到了显著改善,表现为神经纤维密度、长度、神经反射率和扭曲度增加,以及治疗后珠状和神经瘤的发生率降低。神经再生的程度与患者报告的光过敏改善相关。脐带血浆滴眼剂也显示出缓解症状和促进角膜神经再生的潜力。未来的临床实践和研究方向包括标准化制剂制备方案、制定治疗指南、阐明潜在机制、进行长期临床试验以及实施成本效益措施,如扩大生产。随着不断的进展,血源性滴眼剂有望成为 NCP 患者的一种有价值的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970d/11296151/e2e50d6c4a6a/jop.2023.0155_figure1.jpg

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