4.3角膜溃疡
由于角膜溃疡中各种组织降解酶在病情发展中发挥了重要的作用,如果可以增强角膜组织对抗酶消化作用的能力,无疑可以延缓组织溃疡的发展[2]。受此启发,Moren等[20]对一个由于配戴角膜接触镜引起单眼角膜溃疡的女性进行治疗,实验检查排除单纯疱疹病毒,细菌和棘阿米巴感染,患者最佳矫正视力(BCVA)0.02,开始应用广谱抗生素治疗1mo,角膜继续浸润性溃疡、角膜变薄。考虑患者对常规治疗无效果后,给予患者使用CCL治疗。治疗过程中观察患者的疼痛和坏死物质迅速减少,几天内角膜上皮开始恢复,1mo后上皮完全长好,2mo后溃疡基本恢复,治疗9mo后,BCVA 20/30。这个病例表明CCL对感染性角膜炎的治疗有积极的影响,患者治疗后最终的视觉效果令人满意。尽管这项技术并不成熟,但这可能是一种很有前景的治疗角膜炎的新方法。
5前景与展望
紫外光核黄素角膜交联疗法的出现,为圆锥角膜、医源性角膜扩张、角膜溃疡等疾病的治疗带来了新的希望。尽管实验和临床研究已经初步证实了该疗法的作用机制和疗效,在减轻患者治疗上的不适亦取得了进一步成效,但是作为一个新的治疗手段,紫外光核黄素角膜交联疗法还不够完善,在此基础上不断会有新的疗法产生,并且远期疗效和安全性尚需进一步研究。另外,最近一项研究 表明紫外光核黄素交联作用可以提高巩膜的机械强度,进行性近视发病的重要原因可能是巩膜的生物力学强度下降和变薄[21],利用紫外光核黄素交联疗法使巩膜纤维发生交联而增强其强度,阻止或延缓近视的病理进程,但同时此手术中需暴露巩膜,对视网膜有细胞毒性作用影响治疗中辐射范围[22]。 此外,利用CCL使角膜基质发生水合作用(交联程度越高,水肿程度越低),使交联术治疗大疱性角膜病变等病成为了可能[23],然而这一切都需要我们做进一步研究,完善手术方法,提高疗效及应用范围。
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