作者：朱洪丽 作者单位：110031）中国辽宁省沈阳市第四人民医院眼科
【摘要】 目的：观察板层角膜烧灼术治疗大泡性角膜病变（bullous keratopathy，BK）的手术疗效。
【关键词】 大泡性角膜病变；角膜板层烧灼
Lamellar cauterization of cornea for the treatment of bullous keratopathy HongLi Zhu The 4th Peoples Hospital of Shenyang, Shenyang 110031, Liaoning Province, China Abstract AIM: To study the clinical effects of lamellar cauterization of cornea in treating bullous keratopathy (BK). METHODS: A total of 12 cases (12 eyes), including 3 cases caused by agerelated cataract extraction and posterior chamber intraocular lens implantation, 4 cases after phacoemulsification, 1 case after combined surgery, 3 cases caused by absolute glaucoma, 1 case by eye trauma, 6 cases with preoperative eye irritation and no light perception, 2 cases with inaccurate light perception and light positioning, and 4 cases with hand movement, were treated by lamellar cauterization of cornea.
RESULTS: Irritation such as orbital pain symptom was relieved and disappeared 1 day after operation. No recurrences of BK or complications were observed in the following 2 to 24 months. 57 days after operation, corneal edema alleviated and epithelial blisters disappeared under slit lamp. The followup lasted for 2 months to 2 years. Postoperative visual acuity increased to 0.02, and stimulating symptoms disappeared. Hoar turbid was observed in cornea layers under the slit lamp. No recurrence and complications occured.
CONCLUSION: Treating BK by lamellar cauterization of cornea can effectively alleviate the symptom and prevent recurrence.
KEYWORDS: bullous keratopathy; lamellar cauterization of cornea
方法：对12例12眼BK患者采用角膜板层烧灼术治疗，由老年性白内障囊外摘除后房型人工晶状体植入术后发病3例，白内障超声乳化术后发病4例，青光眼白内障联合术后1例，绝对期青光眼引起3例，眼外伤引起1例，术前眼部刺激症状明显，视力6例无光感，2例光感，光定位不准确，4例眼前手动。均行角膜板层切开，层间烧灼角膜实质层术。
结果：术后1d，眼部疼痛等刺激症状缓解，刺激症状消失。术后5～7d裂隙灯下见角膜水肿减轻，上皮水泡消失。随访2mo～2a，术后视力由术前的光感及眼前手动提高至眼前指数及0.02，刺激症状消失。裂隙灯下见角膜层间有灰白色混浊。均未发现BK复发及并发症的发生。
结论：此手术方法疗效肯定，可有效地控制BK的症状，防止BK的复发，患者创伤较小，治疗费用较低。是治疗BK可供选择的有效方法。
0引言 临床上治疗大泡性角膜病变（bullous keratopathy，BK）尚无特效药物，公认的治疗方法是穿通性角膜移植。由于条件限制不能普及，且有的病例也不适合手术。我院自2002年以来，采用角膜板层烧烙的方法治疗12例12眼BK患者，获得了满意的效果，现报告如下。
1对象和方法
1.1对象 12例12眼患者中，男7例，女5例，均单眼发病，43～78岁，右眼8例，左眼4例。老年性白内障囊外摘除人工晶状体植入术后发病3例，白内障超声乳化术后发病4例，青光眼白内障联合术后1例，绝对期青光眼引起3例，眼外伤引起1例。病程3mo～5a。光感阴性6例，光感者2例，眼前手动者4例，绝对期青光眼3例，眼压>5.78kPa，其余9例眼压在正常范围。所有患者均有明确的BK表现：明显的眼睑痉挛、眼部磨痛、畏光、流泪，患眼充血明显，角膜混浊水肿有大小不等的散在上皮型水泡，有的已破裂，瞳孔轮廓隐约可见。多数眼内结构视不清。
1.2方法 采用角膜层间烧灼法治疗，步骤如下：（1）常规消毒，用4g/L表面麻醉药点眼3次，眼部症状严重者选用20g/L利多卡因球后麻醉；（2）开睑器开睑，结膜下浸润麻醉，做上直肌牵引固定缝线；（3）近角膜缘处切开除5∶00～7∶00方位外约1/2厚度角膜，将板层翻转后开始烧灼；（4）用烧灼的大头针帽烧灼植床，使角膜呈现均匀一致的灰白色；（5）恢复角膜瓣,用100尼龙线间断缝合板层角膜；（6）球结膜下注射抗生素30mg，氟美松2.5mg，包扎术眼。术毕抗生素眼膏点眼，抗炎及对症治疗。
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