关注0.1%CsA阳离子乳剂在眼表免疫性疾病中的合理选择及应用

Focusing on the rational application of 0.1%CsA cationic emulsion in ocular surface inflammatory disorder

眼表免疫性疾病(OSID)是由全身免疫性疾病引起,或是有局部免疫系统参与的慢性炎性眼部疾病,通过在眼及其附属器产生持续性炎症而引起泪液高渗环境和眼表上皮损伤,从而导致或加重干眼。常见的免疫炎性相关眼表疾病包括春季角结膜炎(VKC)、干燥综合征、移植物抗宿主病、干眼、免疫性角膜疾病等,严重影响患者的视觉功能和生活质量。目前,OSID主要采用人工泪液和糖皮质激素滴眼液进行治疗,但治疗效果欠佳且不良反应风险较大,因此OSID的有效治疗一直面临很大挑战。环孢素A(CsA)是一种临床常用的免疫抑制剂,具有很强的免疫调节作用,但由于其既有眼用剂型的通透性低,在临床上的应用受到一定限制。CsA眼用制剂的研发改变了OSID的治疗策略,近来研发的0.1%CsA阳离子乳剂显著提高了CsA局部应用的作用效果及安全性,值得临床医生关注。眼科医生应该充分认识各种OSID的免疫相关病理机制,充分了解0.1%CsA阳离子乳剂对OSID的疗效、适应证、眼表局部应用方法、不良反应等,进而在各种OSID的治疗中进行合理选择。

Ocular surface inflammatory disorder(OSID)is a chronic ocular disease caused by systemic disorders or involving the local immune system.OSID induces persistent inflammatory reaction in the ocular adnexal connective tissues which in turn give rise to tear hypertonicity and ocular surface epithelial damage,leading to dry eye formation or progression.Common immune-related ocular surface diseases include vernal keratoconjunctivitis,Sj gren syndrome,graft versus host disease,dry eye and immune-related corneal disease,all of which can significantly impact the visual function and quality of life of patients.Current treatments including the use of artificial tears and glucocorticoid eye drops are not always effective and have the risk of adverse events.Cyclosporine A(CsA)is a commonly utilized immunosuppressant that has a strong immunomodulatory effect,but its clinical application is somewhat limited due to the low permeability of its current ophthalmic dosage form.The development of CsA ophthalmic agents has changed the treatment strategy for OSID.The development of 0.1%CsA cationic emulsion has significantly improved the efficacy and safety of topical CsA treatment,which is worth the attention.In order to rationally apply 0.1%CsA cationic emulsion to OSID,ophthalmologists should fully understand the immune-related pathogenesis of each OSID and comprehend the curative effect,indication,application methods and adverse events of topical CsA treatment.