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高风险角膜移植的治疗 Management of high-risk corneal transplantation

Di, Z.A., Kheirkhah, A., Abud, T.B., Goyal, S., Dana, R.

期刊名称:Survey of Ophthalmology

卷期:2017年第62卷第6期

关键词:
角膜 高风险

摘要

摘要:角膜是医学中最常用的移植组织。角膜移植失败的主要原因是同种异体移植排斥。移植排斥的发生率取决于是否存在高风险特征,最显着的是角膜新生血管形成。虽然在没有这些危险因素的情况下角膜移植成功率高,但由于免疫介导的移植排斥反应的高发生率,角膜成形术风险高,成功率低。为了提高高风险角膜移植的存活率,可以考虑各种术前,术中和术后措施;然而,管理这些移植物的关键步骤是长期使用局部和/或系统免疫抑制剂。虽然一些免疫抑制剂已被用于此目的,但不同研究的结果明显不同。这部分是由于缺乏对其使用的优化方法,以及对每例患者风险程度的精确分层。新的靶向生物治疗以及耐受诱导方法在近期对高风险角膜移植治疗显示出有希望。

The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal grafting has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates because of a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered; however, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents. Although a number of immunosuppressive agents have been used for this purpose, the results vary significantly across different studies. This is partly due to the lack of an optimized method for their use, as well as the lack of a precise stratification of the degree of risk in each individual patient. New targeted biologic treatments, as well as tolerance-inducing methods, show promising horizons in the management of high-risk corneal transplantation in near future.


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