corneal dystrophy

角膜营养不良
  • 文章类型: Journal Article
    目的:本综述将总结FECD相关基因和病理生理学,诊断,目前的治疗方法,以及未来的治疗前景。
    方法:文献综述。
    结果:Fuchs'内皮角膜营养不良(FECD)是最常见的双侧角膜营养不良,占美国所有角膜移植的三分之一。FECD是由遗传因素和非遗传因素共同引起的,有两种类型:早发性FECD,从早期开始影响个体,通常更严重,和迟发性FECD,这更常见,通常表现在40岁左右。FECD的标志发现包括角膜内皮细胞的进行性丧失和在Descemet膜上形成局灶性增生(guttae)。这些病理生理变化导致进行性内皮功能障碍,导致后期视力下降和失明。本文将对FECD相关基因及其病理生理学进行综述,诊断,目前的治疗方法,以及未来的治疗前景。
    结论:随着对FECD相关基因的表征和理解以及对角膜内皮再生疗法的持续研究,我们希望将来在疾病的管理和护理方面看到更多的重大改进。
    OBJECTIVE: The present review will summarize FECD-associated genes and pathophysiology, diagnosis, current  therapeutic approaches, and future treatment perspectives.
    METHODS: Literature review.
    RESULTS: Fuchs\' endothelial corneal dystrophy (FECD) is the most common bilateral corneal dystrophy and accounts for one-third of all corneal transplants performed in the US. FECD is caused by a combination of genetic and non-heritable factors, and there are two types: early-onset FECD, which affects individuals from an early age and is usually more severe, and late-onset FECD, which is more common and typically manifests around the age of 40. The hallmark findings of FECD include progressive loss of corneal endothelial cells and the formation of focal excrescences (guttae) on the Descemet membrane. These pathophysiological changes result in progressive endothelial dysfunction, leading to a decrease in visual acuity and blindness in later stages. The present review will summarize FECD-associated genes and pathophysiology, diagnosis, current therapeutic approaches, and future treatment perspectives.
    CONCLUSIONS: With the characterization and understanding of FECD-related genes and ongoing research into regenerative therapies for corneal endothelium, we can hope to see more significant improvements in the future in the management and care of the disease.
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  • 文章类型: Journal Article
    目的:对有关经典格子角膜营养不良(LCD)的现有和理论治疗方式的最新文献进行简要总结和比较。本文旨在支持从业人员对这种疾病的管理。
    方法:通过PubMed和GoogleScholar对截至2023年1月与LCD治疗有关的英语文章的现有文献进行了搜索。由于缺乏有关LCD的特定新疗法的文献,其他角膜病变的结果(颗粒状角膜营养不良,角膜疤痕)有时会包括在内以进行对比,这是明确表示。
    结果:LCD是一种缓慢进展的疾病,可导致复发性角膜上皮糜烂,基质雾霾,角膜混浊,严重的不适,和视力障碍。由于其常染色体显性遗传模式,这种疾病可以在整个祖先系中持续存在,需要一致的治疗和随访。一个最佳的管理计划是必要的(1)延长寿命与最佳可实现的视力;(2)治疗疼痛性复发性角膜糜烂发生;(3)确保适当的随访在整个生命的患者,以及监测高危后代;(4)监测治疗效果。
    结论:本文讨论了(1)早期疾病的治疗,包括角膜上皮清创,光治疗性角膜切除术(PTK),飞秒激光辅助板层角膜切削术(FLK),和其他;(2)治疗晚期疾病,包括全厚度角膜移植术和前板层角膜移植术;和(3)潜在的未来治疗考虑因素,包括各种局部/全身,遗传,和再生方法。
    OBJECTIVE: To provide a brief summary and comparison of the most recent literature on available and theorized treatment modalities for classic lattice corneal dystrophy (LCD). This paper aims to support practitioners in their management of this disease.
    METHODS: A search was carried out on available literature through PubMed and Google Scholar of English language articles up to January 2023 that relate to the treatment of LCD. Due to scarcity of literature regarding specific novel therapies for LCD, results from other corneal pathologies (granular corneal dystrophy, corneal scarring) are sometimes included for contrast, which is clearly denoted.
    RESULTS: LCD is a slowly progressive disease that leads to recurrent epithelial corneal erosions, stromal haze, corneal opacification, substantial discomfort, and visual impairment. Due to its autosomal-dominant inheritance pattern, this disease can persist throughout ancestral lines and requires consistent treatment and follow-up. An optimal management plan is necessary to (1) prolong years of life with best achievable visual acuity; (2) treat painful recurrent corneal erosions as they occur; (3) ensure proper follow-up throughout the life of a patient, as well as monitor at-risk offspring; and (4) monitor efficacy of treatment.
    CONCLUSIONS: This paper addresses (1) treatment for early disease including corneal epithelial debridement, photo therapeutic keratectomy (PTK), femtosecond laser-assisted lamellar keratectomy (FLK), and others; (2) treatment for late disease including full thickness keratoplasties and anterior lamellar keratoplasties; and (3) potential future treatment considerations including a wide variety of topical/systemic, genetic, and regenerative approaches.
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  • 文章类型: Systematic Review
    背景:光疗角膜切除术(PTK)已越来越多地用于治疗对其他治疗无反应的严重复发性角膜糜烂综合征(RCES)患者。然而,由于比率不同,目前每项研究的疗效和并发症尚不确定.
    目的:本研究的目的是探讨光疗角膜切除术治疗复发性角膜糜烂的安全性和有效性。
    方法:本文对Cochrane进行了系统的文献研究,Embase,PubMed,Scopus,和WebofScience有关PTK治疗RCES的文献,直到2022年12月20日。提取的数据包括复发率和不良事件发生率用于荟萃分析。
    结果:复发率为18%(95%CI,13%-24%)(129/700眼)。亚组分析显示,损伤后RCE复发率为17%(95%CI,9%-24%),角膜营养不良组为22%(95%CI,11%-32%)。治疗相关的不良事件包括上皮下霾,远视移位,最佳眼镜矫正视力(BSCVA)下降。在这项研究中,这些事件的发生率为13%(95%CI,6%-21%),20%(95%CI,11%-28%),和11%(95%CI,5%-16%),分别。
    结论:PTK是复发性角膜糜烂患者的一种有价值的治疗选择,尤其是那些有外伤的人,副作用很小。
    BACKGROUND: Phototherapeutic keratectomy (PTK) has been increasingly used to treat severe recurrent corneal erosion syndrome (RCES) patients who do not respond to other treatments. However, the efficacy and complication of each study are currently uncertain due to varying rates.
    OBJECTIVE: The objective of this study was to investigate the safety and efficacy of the PTK for recurrent corneal erosions.
    METHODS: This article performed a systematic literature research in Cochrane, Embase, PubMed, Scopus, and the Web of Science for the literature on PTK treatment of RCES until December 20, 2022. The extracted data including recurrence rate and the adverse event rate were used for meta-analysis.
    RESULTS: The recurrence rate was 18% (95% CI, 13%-24%) (129/700 eyes). Subgroup analysis showed that the RCE recurrence was 17% (95% CI, 9%-24%) after trauma and 22% (95% CI, 11%-32%) in the corneal dystrophy group. Treatment-related adverse events included subepithelial haze, hyperopic shift, and decrease of the best spectacle-corrected visual acuity. In this study, the incidence of these events was 13% (95% CI, 6%-21%), 20% (95% CI, 11%-28%), and 11% (95% CI, 5%-16%), respectively.
    CONCLUSIONS: PTK represented a valuable treatment option for patients with recurrent corneal erosions, especially those with traumatic injuries, which had minimal side effects.
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  • 文章类型: Journal Article
    目的:颗粒性和晶格性角膜营养不良(GCD和LCD)是角膜的常染色体显性遗传性疾病。由于遗传异质性和大基因,解开突变是具有挑战性的。
    方法:患者接受全面的临床检查,靶向下一代测序(NGS)用于突变检测.完成了共偏析和硅分析。
    结果:患者患有GCD。NGS披露了一种已知的致病变异,c.371G>A(p。R124H),在TGFBI的第4外显子.该变体与家族中的表型共分离。纯合子患者表现出更严重的表型。在杂合患者中观察到可变表达。
    结论:结果,根据以前的研究,表明TGFBI中的c.371G>A与GCD相关联。一些表型变异与修饰基因等因素有关,减少外显率和环境影响。
    OBJECTIVE: Granular and lattice corneal dystrophies (GCDs & LCDs) are autosomal dominant inherited disorders of the cornea. Due to genetic heterogeneity and large genes, unraveling the mutation is challenging.
    METHODS: Patients underwent comprehensive clinical examination, and targeted next-generation sequencing (NGS) was used for mutation detection. Co-segregation and in silico analysis was accomplished.
    RESULTS: Patients suffered from GCD. NGS disclosed a known pathogenic variant, c.371G>A (p.R124H), in exon 4 of TGFBI. The variant co-segregated with the phenotype in the family. Homozygous patients manifested with more severe phenotypes. Variable expressivity was observed among heterozygous patients.
    CONCLUSIONS: The results, in accordance with previous studies, indicate that the c.371G>A in TGFBI is associated with GCD. Some phenotypic variations are related to factors such as modifier genes, reduced penetrance and environmental effects.
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  • 文章类型: Journal Article
    Corneal dystrophy is a common type of hereditary corneal diseases. It includes many types, which have varied pathology, histology and clinical manifestations. Recently, the examination techniques of ophthalmology and gene sequencing advance greatly, which do benefit to our understanding of these diseases. However, many aspects remain still unknown. And due to the poor knowledge of these diseases, the results of the treatments are not satisfoctory. The purpose of this review was to summarize the clinical, histological and genetic characteristics of different types of corneal dystrophies.
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  • 文章类型: Case Reports
    METHODS: Posterior Polymorphous Dystrophy (DPP) is a rare posterior corneal dystrophy that is genetically transmitted as autosomal dominant. Corneal structures affected in this dystrophy are Descemet membrane and the endothelium. A case is presented on a 47 years old woman with no relevant history, with typical findings of DPP (vesicular and band lesions at the endothelium and posterior Descemet).
    CONCLUSIONS: To our knowledge there are no reported cases of DPP in Latin-American patients in the literature. The clinical manifestations in our patient were found to be very similar to the cases reported in other populations.
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  • 文章类型: Journal Article
    Many of the corneal dystrophies have now been genetically characterized, and a system was established in 2008 by The International Committee for Classification of Corneal Dystrophies (IC3D) in an attempt to standardize the nomenclature. IC3D provided a classification system whereby all dystrophies can be categorized on the basis of the underlying genetic knowledge. Since that time, further work has established even more phenotypic and allelic heterogeneity than anticipated, particular for Fuchs endothelial corneal dystrophy and posterior polymorphous dystrophy. Using genome-wide association studies, a number of genes are now implicated both in normal corneal quantitative traits, such as central corneal thickness, as well as in disease. There is also a trend towards functional characterization of the genetic variants involved to elucidate the pathophysiology of these entities. This review article will provide an overview of the knowledge to date, with an emphasis on findings since the IC3D classification was published in 2008.
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