作者：唐柳苹 作者单位：(545006)中国广西壮族自治区柳州市，广西医科大学第五附属医院眼科 柳州市人民医院
【摘要】 目的：评价羊膜移植几种手术方法治疗大泡性角膜病变的临床效果。方法：对18例大泡性角膜病变患者，分别采取角膜层间烧烙术、新鲜羊膜移植术、角膜灼烙联合羊膜嵌入移植手术。结果：18例大泡性角膜病变患者，术后1～5d疼痛消失，7～12d角膜上皮修复，7～21d后羊膜植片常规溶解。角膜层间烧烙术1眼、新鲜羊膜移植术3眼术后1～2mo再次出现角膜大泡及角膜刺激症状而再次手术。角膜灼烙联合羊膜嵌入移植术，术后当天疼痛消失，14d角膜上皮光滑，角膜大泡消失。随访6～18mo无1例复发，部分患者视力有不同程度的提高。结论：角膜灼烙联合羊膜嵌入移植对大泡性角膜病变具有明显的治疗效果。
【关键词】 大泡性角膜病变;角膜灼烙;羊膜嵌入移植
Retrospective analysis of surgical outcomes in 18 cases with bullous keratopathy
LiuPing Tang
Department of Ophthalmology, the Fifth Affiliated Hospital of Guangxi Medical University, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China
Abstract
AIM: To evaluate the clinical effect of amniotic membrane transplantation in the treatment of bullous keratopathy.
METHODS: Eighteen patients of bullous keratopathy were treated with intralamellar cauterization of cornea, fresh amniotic membrane transplantation, intralamellar cauterization of cornea with amniotic membrane transplantation respectively.
RESULTS: In all 18 patients of bullous keratopathy, the pain subsided within 15 days after surgery; corneal epithelium repaired over within 712 days after surgery; and amniotic membrane was dissolved within 13 weeks after surgery. One eye treated with intralamellar cauterization of cornea and three cases treated with fresh amniotic membrane transplantation were reoperated because epithelial bubble and cornea exciting symptom appeared. In all cases treated with intralamellar cauterization of cornea with amniotic membrane transplantation, the pain subsided; the epithelium were smooth ,and epithelial bubble was disappeared in the day of surgery. During the follow up of 618 months, no recurrence occurred during followup period, and those cases experienced postoperative vision improvement in various degree.
CONCLUSION: Intralamellar cauterization of cornea with amniotic membrane transplantation has significant curative effect on bullous keratopathy.
KEYWORDS: bullous keratopathy; intralamellar cauterization of cornea; amniotic membrane transplantation
Tang LP. Retrospective analysis of surgical outcomes in 18 cases with bullous keratopathy. Int J Ophthalmol(Guoji Yanke Zazhi) 2009;9(7):13541355
0引言
大泡性角膜病变(bullons keratopathy，BK)，是以角膜内皮代偿失调以及角膜基质水肿,伴有角膜上皮水肿为特征的角膜病变。可引起剧烈的疼痛、畏光、流泪等角膜刺激症状。单纯药物治疗难以控制病程，穿透性角膜移植是目前治疗BK的首选方法，但由于材料的限制，很多患者得不到及时的治疗而疼痛难忍。不得不摘除眼球。目前羊膜移植已逐渐用于治疗大泡性角膜病变，缓解患者的疼痛，仍可保存部分仅有的视功能，但手术方式各有差异。我们分别采取角膜层间烧烙术、新鲜羊膜移植术、角膜灼烙联合羊膜嵌入移植治疗大泡性角膜病变18例，现将其3种手术方法疗效回顾性分析。
1对象和方法
1.1对象 我院自200401/200709治疗BK患者18例18眼，男7例，女11例。年龄58～73(平均65)岁，病程8～18mo。致病原因：白内障超声乳化联合人工晶状体植入术3例;白内障囊外摘除联合人工晶状体植入术10例;青光眼绝对期或近绝对期3例;外伤性白内障人工晶状体植入术2例。视力：无光感2眼;光感3眼;手动4眼;指数8眼;视力0.02者1眼。所有患者均有反复剧烈眼痛以及畏光、流泪等刺激症状，角膜有不同程度的水肿混浊，呈灰白色，角膜有大小和数目不等的大泡存在。
1.2方法
1.2.1手术术式 采用角膜层间烧烙术2眼;新鲜羊膜移植术6眼;角膜灼烙联合羊膜嵌入移植术10眼。其中有原行角膜层间烧烙术1眼，羊膜移植术3眼，术后1～2mo再次出现角膜大泡及角膜刺激症状，再次手术时采用角膜灼烙联合羊膜嵌入移植术。
1.2.2羊膜采集 取当天剖腹产婴儿胎盘，临床上常规检查已排除乙肝、丙肝、梅毒、HIV等疾病的健康孕妇。将羊膜组织整层自胎盘剥离，无菌生理盐水冲洗干净，并用庆大霉素漂洗，显微镜下刀片尽量刮除其海绵层，部分纤维母细胞层及浆液性渗出物。剪下薄层羊膜备用，全部手术均在取材6h内进行。
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