关注免疫炎症调控在青光眼全程诊疗中的作用

New paradigms of immune regulation in glaucoma during the whole clinical process

青光眼是由于病理性眼压升高引起视神经结构和功能损害而导致的不可逆性致盲眼病,具有多因性、强异质性的特点,长期以来降低并控制眼压以减轻视神经损害是青光眼主要的治疗策略。然而,临床实践中发现,尽管部分青光眼患者眼压得到控制,但视神经损害仍持续进展,因此非眼压依赖性的继发视神经损害仍为青光眼发生和发展病理机制中亟需解决的瓶颈问题和研究热点。随着分子生物学研究技术的不断进步,医学基础研究领域已取得突破性进展,青光眼患者缓解局部免疫炎症反应可促进部分视觉恢复。但是由于目前尚无标志性临床应用成果,因此重视基础和临床研究相结合,促进成果转化为目前当务之急。研究者及眼科医师应从青光眼-免疫炎症理论出发理解眼部免疫稳态的重要性,关注眼脑之间生理病理过程的相互关联及全视路的病程进展,充分理解和有效利用新的生物学研究技术为青光眼致病机制研究带来的机遇与启示,进而为全临床青光眼诊疗方案的制定提供指导作用。

Glaucoma is an irreversible blinding eye disease caused by the structural and functional damage of optic nerve induced by pathological increase of intraocular pressure(IOP),characterized by multiple causes and strong heterogeneity.The control of IOP to reduce the risk of optic damage has been the main therapeutic strategy of glaucoma for many years.However,in clinical experience,some patients show progress of optic nerve damage despite the effectively controlled IOP,the mechanism of non-IOP-dependent secondary damage is still an urgent problem to be solved and a research hotspot in the pathogenesis of glaucoma.With the continuous innovation of molecular biological technology,breakthroughs have been made in the field of basic research.Partial visual recovery can be boosted by alleviating local immune and inflammatory responses.Due to a lack of symbolic clinical application results,it has become an immediate priority to attach importance to the combination of basic clinical research and facilitate the transformation of results.Starting from the theory of glaucoma-immune inflammation,understanding the importance of the immune homeostasis of eyes,paying close attention to the linkage of eyes and brain in physiopathological process and the progression of diseases in the whole visual pathway,and fully understanding and effectively making good use of the opportunities and implications brought by new techniques will have significant effect in formulating clinical diagnosis and treatment plans.