Mechanisms involved in the side effects of glucocorticoids

eMedicine创建于1996年，由近万名临床医师作为作者或编辑参与此临床医学知识库的建设，其中编辑均是来自美国哈佛、耶鲁、斯坦福、芝加哥、德克萨斯、加州大学等各分校医学院的教授或副教授。

eMedicine

The multifunctional choroid.

The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjogren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.

TFOS DEWS II pathophysiology report

Age-related macular degeneration: etiology, pathogenesis, and therapeutic strategies.

https://www.gastrojournal.org/article/0016-5085(92)90319-T/pdf

Corticosteroid treatment for inflammatory bowel disease in pediatric patients increases intraocular pressure.

By exposing primary cultures of human corneal epithelial cells to a single dose of either benzalkonium chloride or chlorobutanol, evaluated the cytotoxicity of these two preservatives which are commonly used in artificial tear solutions and other topical ophthalmic medications. Control and experimental cultures were analyzed by continuous time-lapse videomicrographic recordings as well as by sequential phase-contrast microscopy. Both benzalkonium chloride at a concentration of 0.01% and chlorobutanol at 0.5% caused immediate cessation of normal cytokinesis and mitotic activity, and epithelial cells degenerated within two hours and eight hours, respectively.

Cytotoxic effects of benzalkonium chloride and chlorobutanol on human corneal epithelial cells in vitro.

Several of the known growth factors either have an effect on corneal tissues or can be isolated from them. Both epidermal growth factor (EGF) and fibroblast growth factor (FGF) stimulate the proliferation of corneal epithelium, keratocytes, and endothelium. Compared to FGF, EGF is more potent in stimulating the growth of endothelial cells; it also increases the tensile strength of corneal stromal wounds. The corneal epithelium produces an angiogenic growth factor as well as a neuronotrophic growth factor. Insulin-like growth factor stimulates the growth of keratocytes and enhances the effect of EGF on the corneal endothelium. Mesodermal growth factor stimulates the proliferation of keratocytes and increases the rate of healing of damaged corneal endothelial cells. It is evident that growth factors have many potential clinical applications especially in accelerating corneal wound repair after surgery, chemical burns, or ulcers, and in increasing the numbers of corneal endothelial cells in aging and diseased corneas, as well as in donor corneas to be used for transplantation. Several parameters require evaluation, e.g. the dose, concentration, combination and formulation, exposure time, receptor affinity, and tissue interdependence of the growth factor(s), as well as the variability in patient response and severity of disease and/or injury. Investigations are also needed for the development of effective delivery systems and for determining whether growth factors are specific and safe in humans. Growth factors are emerging as a new generation of ophthalmic pharmaceuticals, and they will soon be integrated into the advancing practice of ophthalmic surgery and medicine.

Brenda J. Tripathi

Papers

Corticosteroid treatment for inflammatory bowel disease in pediatric patients increases intraocular pressure.

Cytotoxic effects of benzalkonium chloride and chlorobutanol on human corneal epithelial cells in vitro.

Corneal growth factors: a new generation of ophthalmic pharmaceuticals.

Growth factors in the aqueous humor and their clinical significance.

Detection, quantification, and significance of basic fibroblast growth factor in the aqueous humor of man, cat, dog and pig.