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Abstract：
N-acetylcysteine (NAC) was first discovered as a mucolytic agent in 1960. We investigate the role of topical NAC in ocular therapeutics, including its mechanism of action, current applications, and adverse effects. A systematic search of peer-reviewed articles identified 106 references including in vitro, in vivo and clinical studies on the use of NAC in the treatment of ocular diseases. NAC can be synthetically manufactured, and its mechanisms of action include mucolysis, scavenging hydroxyl radicals, and modulation of inflammatory cascades. These unique properties contribute to the diverse applications of NAC, including its steroid-sparing potential. NAC has been used topically in the treatment of corneal wounds, chemical injuries, keratitis, dry eye disease and meibomian gland dysfunction. The clinical benefits of NAC are evident over a wide range of concentrations, the most common being 5-10% topical NAC applied four times daily. Adverse effects such as corneal necrosis are rare, but have been reported with higher doses. NAC also has potential applications in laser epithelial keratomileusis, diabetic eye disease, retinitis pigmentosa, senile nuclear cataracts, macular degeneration, and cigarette smoke-induced corneal damage. Recently, chitosan-NAC has been used as a nanocarrier for the topical administration of medications to the ocular surface. Owing to its potent antioxidant, anti-inflammatory and mucolytic properties, topical NAC has had extensive use in the treatment of ocular pathology.
摘要：
N-乙酰半胱氨酸(NAC)在1960年作为粘液溶解剂首次被发现。我们研究了局部NAC在眼部治疗中的作用，包括它的作用机制，当前应用，和不利影响。对同行评审的文章进行了系统的搜索，确定了106篇参考文献，包括体外，使用NAC治疗眼病的体内和临床研究。NAC可以合成制造，其作用机制包括粘液溶解，清除羟基自由基，和炎症级联的调节。这些独特的特性有助于NAC的多样化应用，包括它节省类固醇的潜力。NAC已局部用于治疗角膜伤口，化学损伤,角膜炎,干眼症和睑板腺功能障碍。在广泛的浓度范围内，NAC的临床益处是显而易见的，最常见的是5-10％的局部NAC每天应用四次。角膜坏死等不良反应很少见，但是据报道剂量较高。NAC在激光上皮性角膜磨镶术中也有潜在的应用，糖尿病性眼病,视网膜色素变性,老年性核性白内障，黄斑变性,和香烟烟雾引起的角膜损伤。最近,壳聚糖-NAC已被用作纳米载体,用于将药物局部施用至眼表面。由于其强大的抗氧化剂，抗炎和粘液溶解特性，局部NAC已广泛用于眼部病理的治疗。
