环孢素A在眼表移植和角膜炎症中的应用

Clinical applications of cyclosporine A in allograft and inflammatory diseases of the ocular surface

目的 探讨环孢素A (CyclosporineA ,CsA)在眼表移植手术和炎症性疾病中的疗效和相关影响因素。方法 通过10 6眼眼表手术(羊膜贴敷71眼、穿透性角膜移植2 0眼、指环形/全角膜上皮移植15眼)的术后用药和32眼角膜炎症性疾患(干燥性角结膜炎8例16眼、蚕蚀性角膜溃疡3例4眼、单疱角膜基质炎2例2眼、表层点状角膜病变7例10眼)的系统治疗观察,对临床疗效作回顾性研究。用药途径:穿透性角膜移植和指环形/全角膜上皮移植病例,术后口服CsA6w～8w ,联合局部0 . 5 %CsA滴眼剂3次～4次/d ,持续用药8m～12m ;羊膜贴敷者仅在术后0 . 5 %CsA滴眼剂3次/d ,持续用药8m～12m ;角膜炎症性病例中蚕蚀性角膜溃疡4眼中3眼采用病灶切除后羊膜贴敷联合局部用药,1眼单用0 . 5 %CsA局部滴眼;其他病例按病种不同,分别应用0 . 1%～0 . 5 %CsA局部滴眼3～4次/d联合相关对因治疗。结果 135眼治疗者中有12 8眼随访6m～36m ,7眼为新近观察病例,仅随访3m～6m。35眼穿透性角膜移植和指环形/全角膜上皮移植术中,仅3眼因移植排斥致角膜血管化,32眼透明愈合,获得91. 4 %的移植成功率;所有重症烧伤羊膜贴敷患者,术后眼表重新上皮化且未遗留睑球粘连。70 %以上病例瞳孔区角膜维持透明而重获有用视力;角膜炎症性疾病中,4眼蚕蚀性溃疡随访2

Objective To investigate the effect of cyclosporine A(CsA)in ocular surface inflammations and allograft.Methods 106 eyes with ocular surface burns and inflammation after allograft/amniotic membrane patching,and 32 eyes withinflammatory diseases of the ocular surface including Mooren′s ulcer,dry eye,herpetic stromal keratitis and superficial punctate keratopathy were treated with systemic and topical administration of cyclosporine A.Results 128 eyes were followed-up for 6 to 36 months,and 7 eyes were followed-up for 3 to 6 months.Thirty-two transparent grafts were acquired in 35 eyes of penetrating keratoplasty and annular/pan-epitheliokeratoplasty.91.4 percent of allograft(32/35)was successful.Over 70% of eyes in amniotic membrane patching were gained useful vision.Sixteen eyes of inflammations including Mooren′s ulcer,herpetic stromal keratitis and superficial punctate keratopathy were cured.No recurrence has followed the stopping of CsA.Sixteen eyes in 8 cases with dry eye gained improvement in Schirmer′s test and symptoms during the treatment.Conclusions Cyclosporine A is a lipophilic polypeptide which is apt to penetrate corneal epithelium then storing in the stroma.CsA suppressed the immunological inflammatory reaction by inhibiting the activation of the helper cells(Th).CsA is an excellent therapeutic agent for allograft and inflammatory disease′s of the ocular surface.