青光眼睫状体炎综合征病因学研究新进展

摘要

青光眼睫状体炎综合征即Posner-Schlossman综合征(PSS),是一组以单眼发病、反复发作的眼压升高及轻度眼前节炎症为特征的眼科少见病.一般认为PSS具有自限性和良性的预后,但部分反复发作的患者可出现视神经损害和视野缺损.目前该病的治疗方式主要是控制眼压和减轻炎症反应,该治疗方法虽然能够缓解PSS急性发作,但并不能减少其复发.因此,研究PSS的病因十分重要.本文综述了近二十年来不同的PSS病因假说——微生物感染学说、过敏学说、血管源性学说、自身免疫和内分泌学说并予以分析.目前研究最多的学说是微生物感染学说,推测水痘-带状疱疹病毒、单纯疱疹病毒作为PSS病因的可能性较小,幽门螺杆菌感染可能与PSS发病及视神经病变有关,巨细胞病毒感染被认为是PSS最有可能的病因,但也存在不支持的证据.由于样本量和技术的限制,过敏学说、血管源性学说、自身免疫和内分泌学说的机制尚不明确.目前,任何一种学说均不能完全解释PSS的发病、转归及预后,提示可能是病原微生物感染等外部因素、自身免疫及内分泌等机体内环境以及基因易感性等自体素质等多因素共同作用的结果.%Posner-Schlossman syndrome (PSS) or glaucomatocyclitic crisis is a rare,unilateral recurrent inflammatory ocular hypertensive disease.Although it is typically self-limited and has benign prognosis,some cases were reported with advanced optic nerve cupping and associated visual field loss.Current therapeutic strategies are mainly focused on controlling intraocular pressure and reducing inflammation.These treatments may relieve acute episode of PSS,but could not decrease the recurrences.Therefore,the etiology of PSS is extremely important.This review summarized and analyzed the advances in the etiology and pathogenesis of PSS in recent twenty years,including microbial infection,allergy,abnormal vascular reactivity,autoimmune and endocrine.Infectious theories are most studied at present.The probabilities of varicella-zoster virus and herpes simplex virus as the etiology of PSS were considered to be very small.Heliobacter pylori was thought to be related to the pathogenesis of PSS and glaucomatous optic nerve injury.The most likely cause of PSS is cytomegalovirus infection,but there existed evidences that opposed the theory.Due to the small sample size and limit of technology,the evidences of allergy,abnormal vascular reactivity,autoimmune and endocrinic factors as the pathogenesis of PSS were not definite.In conclusion,no single factor could explain the etiology and pathogenesis of PSS,multiple factors such as external factor,internal factor and autogenous factor might be involved.