PDF(Pubmed)
Abstract：
OBJECTIVE: Ring infiltrates usually accompany numerous infectious and sterile ocular disorders. Nevertheless, systemic conditions, drugs toxicity and contact lens wear may present with corneal ring infiltrate in substantial part. Considering its detrimental effect on vision, detailed knowledge on etiology, pathophysiology, differential diagnosis, and management should be considered essential for every ophthalmologist.
METHODS: The PUBMED database was searched for \"corneal ring infiltrate\" and \"ring infiltrate\" phrases, \"sterile corneal infiltrate\" and \"corneal infiltrate\". We analyzed articles written in English on risk factors, pathophysiology, clinical manifestation, morphological features, ancillary tests (anterior-segment optical coherence tomography, corneal scraping, in vivo confocal microscopy), differential diagnosis and management of corneal ring infiltrate.
RESULTS: Available literature depicts multifactorial origin of corneal ring infiltrate. Dual immunological pathophysiology, involving both antibodies-dependent and -independent complement activation, is underlined. Furthermore, we found that the worldwide most prevalent among non-infectious and infectious ring infiltrates are ring infiltrates related to contact-lens wear and bacterial keratitis respectively. Despite low incidence of Acanthamoeba keratitis, it manifests with corneal ring infiltrate with the highest proportion of the affected patients (one third). However, similar ring infiltrate might appear as a first sign of general diseases manifestation and require targeted treatment. Every corneal ring infiltrate with compromised epithelium should be scraped and treat as an infectious infiltrate until not proven otherwise. Of note, microbiological ulcer might also lead to immunological ring and therefore require anti-inflammatory treatment.
CONCLUSIONS: Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions. Clinical assessment is crucial for empirical diagnosis. Furthermore, treatment is targeted towards the underlying condition but should begin with anti-infectious regimen until not proven otherwise.
METHODS: The PUBMED database was searched for \"corneal ring infiltrate\" and \"ring infiltrate\" phrases, \"sterile corneal infiltrate\" and \"corneal infiltrate\". We analyzed articles written in English on risk factors, pathophysiology, clinical manifestation, morphological features, ancillary tests (anterior-segment optical coherence tomography, corneal scraping, in vivo confocal microscopy), differential diagnosis and management of corneal ring infiltrate.
RESULTS: Available literature depicts multifactorial origin of corneal ring infiltrate. Dual immunological pathophysiology, involving both antibodies-dependent and -independent complement activation, is underlined. Furthermore, we found that the worldwide most prevalent among non-infectious and infectious ring infiltrates are ring infiltrates related to contact-lens wear and bacterial keratitis respectively. Despite low incidence of Acanthamoeba keratitis, it manifests with corneal ring infiltrate with the highest proportion of the affected patients (one third). However, similar ring infiltrate might appear as a first sign of general diseases manifestation and require targeted treatment. Every corneal ring infiltrate with compromised epithelium should be scraped and treat as an infectious infiltrate until not proven otherwise. Of note, microbiological ulcer might also lead to immunological ring and therefore require anti-inflammatory treatment.
CONCLUSIONS: Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions. Clinical assessment is crucial for empirical diagnosis. Furthermore, treatment is targeted towards the underlying condition but should begin with anti-infectious regimen until not proven otherwise.
摘要：
目的：环浸润通常伴随许多感染性和无菌性眼部疾病。然而，系统条件，药物毒性和隐形眼镜佩戴可能存在角膜环浸润。考虑到它对视力的不利影响，详细的病因知识，病理生理学,鉴别诊断,和管理应该被认为是每个眼科医生必不可少的。
方法：在PUBMED数据库中搜索“角膜环渗透”和“环渗透”短语，“无菌角膜浸润”和“角膜浸润”。我们分析了用英语写的关于风险因素的文章，病理生理学,临床表现,形态特征,辅助测试(眼前段光学相干断层扫描，角膜刮削,体内共聚焦显微镜)，角膜环浸润的鉴别诊断和处理。
结果：现有文献描述了角膜环浸润的多因素起源。双重免疫病理生理学，涉及抗体依赖性和非依赖性补体激活，下划线。此外，我们发现，在非感染性和感染性环浸润中，全球最普遍的是分别与隐形眼镜佩戴和细菌性角膜炎有关的环浸润。尽管棘阿米巴角膜炎的发病率低，它表现为角膜环浸润，受影响的患者比例最高（三分之一）。然而,类似的环浸润可能是一般疾病表现的第一个征兆，需要针对性治疗。每个上皮受损的角膜环浸润物应刮擦并视为感染性浸润物，直到没有其他证明。值得注意的是，微生物溃疡也可能导致免疫环，因此需要抗炎治疗。
结论：角膜环浸润可能不仅由眼部感染和非感染因素引起，但也受系统条件的影响。临床评估对于经验诊断至关重要。此外，治疗是针对潜在的情况，但应该从抗感染方案开始，直到没有其他证明。
方法：在PUBMED数据库中搜索“角膜环渗透”和“环渗透”短语，“无菌角膜浸润”和“角膜浸润”。我们分析了用英语写的关于风险因素的文章，病理生理学,临床表现,形态特征,辅助测试(眼前段光学相干断层扫描，角膜刮削,体内共聚焦显微镜)，角膜环浸润的鉴别诊断和处理。
结果：现有文献描述了角膜环浸润的多因素起源。双重免疫病理生理学，涉及抗体依赖性和非依赖性补体激活，下划线。此外，我们发现，在非感染性和感染性环浸润中，全球最普遍的是分别与隐形眼镜佩戴和细菌性角膜炎有关的环浸润。尽管棘阿米巴角膜炎的发病率低，它表现为角膜环浸润，受影响的患者比例最高（三分之一）。然而,类似的环浸润可能是一般疾病表现的第一个征兆，需要针对性治疗。每个上皮受损的角膜环浸润物应刮擦并视为感染性浸润物，直到没有其他证明。值得注意的是，微生物溃疡也可能导致免疫环，因此需要抗炎治疗。
结论：角膜环浸润可能不仅由眼部感染和非感染因素引起，但也受系统条件的影响。临床评估对于经验诊断至关重要。此外，治疗是针对潜在的情况，但应该从抗感染方案开始，直到没有其他证明。
