蚕蚀性角膜溃疡的临床特点分析

探讨蚕蚀性角膜溃疡患者的临床特点和比较治疗方法的效果。方法对连续治疗的蚕蚀性角膜溃疡患者５５０例的患病年龄,性别,眼别,溃疡部位,溃疡穿孔,溃疡复发情况,以及球结膜切除术,板层角膜移植术及板层角膜移植术联环孢霉素Ａ滴眼的疗效进行分析情况,以及球结膜切除术,板层角膜移植术及板层角膜术联合环孢霉素Ａ滴眼的疗效进行分析。结果平均患病年龄４８．４岁;男：女之比为１：０．７４;双眼患病者１６５例,其中青年患     

A Study of Clinical Characteristics and Treatment of Mooren‘s Ulcer

Objective: To investigate the clinical characteristics and to compare the effects of several therapies of Mooren's corneal ulcer.Methods: 550 consecutive cases of Mooren's corneal ulcer inpatients were analysed, including the age, sex, laterality of the eye, ulcer location , perforative rate, cure rate of surgeries, recurrent rate, and the effects of conjunctiva excision, lamellar keratoplasty (LKP), LKP and plus cyclosporin A eye drop.Results: The average age of onset of the cornea! ulcer was 48.4 years old, the ratio of the male to the female patients was 1:0.74, the bilateral disease was 30% of the total cases, 31.5% of the bilateral disease occurred in the younger group, and 68.5% of the bilateral ulcer occurred in the older group, ulcers located at the limbus of the palpebral fissure were 70% of the total cases, perforative rate was 13.3% , 43.2% of the perforation occurred in the younger group, and 56.8% of the perforation occurred in the older group, recurrent rate of the post-opertion was 25.6%,     

板层角膜移植治疗周边部角膜溃疡穿孔

目的 探讨不同形状的板层角膜移植术(LKP)治疗周边部角膜溃疡穿孔的适应证、疗效及并发症.方法 采用非随机回顾性系列病例研究.选择2003年1月至2006年6月在中山眼科中心住院的40例(42只眼)周边部角膜溃疡穿孔患者,根据溃疡和穿孔区的大小和形状,分别采用半月形LKP(14只眼)、新月形LKP(11只眼)、双凸面形LKP(7只眼)、指环状LKP(5只眼)及全LKP(5只眼)治疗.术后随访3～21个月,观察患者术后视力、角膜透明度、角膜散光及并发症,分析原发病的种类和复发情况.结果 周边部角膜溃疡穿孔的原发病主要有Terrien边缘性角膜变性(15只眼,35.7%),蚕食性角膜溃疡(13只眼,31.0%),单纯疱疹病毒性角膜炎(5只眼,11.9%),眼部化学烧伤或热烧伤(4只眼,9.5%)及周边部角膜扩张性病变(3只眼,7.1%)等.LKP后34只眼(81.0%)板层植片与植床贴合良好,角膜透明.术前13只眼(31.0%)视力为0.1以下,术后仅3只眼(7.1%)视力为低于0.1.术后27只眼(64.3%)视力提高,9只眼(21.4%)最佳矫正视力大于或等于0.5.术后3个月角膜散光为(7.23 ±1.22)D,术后6～9个月(已拆线)角膜散光减少为(3.72 ±1.76)D.术后并发症主要为双前房(8只眼,19.1%),继发性青光眼(8只眼,19.1%)等.结论 LKP治疗周边部角膜溃疡穿孔,可有效修复穿孔,挽救眼球.采用不同形状的LKP可避免损伤过多的正常角膜,制作与植床高度匹配的植片可减轻术后严重角膜散光,从而使大多数患者改善或保存了视力.     

板层角膜移植联合羊膜层间植入治疗重症蚕蚀性角膜溃疡

目的探讨板层角膜移植联合保存人羊膜移植重建角膜基质和眼表结构,治疗重症蚕蚀性角膜溃疡的疗效和安全性。方法重症蚕蚀性角膜溃疡患者5例(5眼),具疼痛性、进行性角膜溶解的临床特征,常规治疗方法疗效差,病变区域累及角膜缘6～12个钟点(平均9个钟点)范围。手术前全身和局部应用皮质类固醇。切除角膜缘处5mm宽的结膜和筋膜组织暴露巩膜。仔细的清除溃疡的基底部和边缘部组织,在坏死组织的表面和新生血管区域行烧灼,单层羊膜覆盖在溃疡区域的表面,10-0尼龙线间断缝合固定。在角膜穿孔的部位,移植多层羊膜以修复角膜基质层。在深层溃疡区域,行板层角膜移植。术后,局部应用人工泪液、抗生素眼液和类固醇眼液。术后观察前房深度、再上皮化速度、炎症状况、角膜基质厚度稳定状况、溃疡复发情况和视力。术后7d每日行常规检查,以后每周复查1次。随访期4～15(平均8.6)月。结果 手术获得了良好的疗效。术后自觉症状消失,眼表炎症明显减退,角膜溃疡的表面上皮稳定愈合,新生血管减少,获得了平滑、湿润的眼表。板层角膜植片平复半透明。未见溃疡复发。术后视力无明显下降。无手术并发症发生。结论 角膜板层移植联合羊膜移植可用于治疗重症蚕蚀性角膜溃疡。     

Microsurgical Treatment of Mooren‘s Ulcer

Objective:To evaluate effect of microsurgery of lamellar keratoplasty(LKP)on Mooren‘s corneal ulcer.Methods:The effect.postoperative astigmatism,postoerative vision,ulcer recurrence of postoperation,and surgical complications of two groups of consecutive Mooren‘s ulcer inpatients treated respectively by non-microsurgery of LKP and microsurgery of LKP were analyzed.Results:There were significant differences of the effect,postoperative astigmatism,postoperative vision,ulcer recurrence of postoperation,and surgical complications be-tween the two groups.The effect and postoperative vision of the microsurgery-treated groupwerebetterthan those ofthenon-microsurgery-treatedgroup.The postoperative astigma-tism,ulcer recurrence of postoperation,and surgical complications of the micro-surgery-treated group were less than those of the nonmicrosurgery-treated group.Conclusion:Microsurgery of LKP of Mooren‘s corneal ulcer can greatly improve the ul-cer healing and postoperative vision,and reduce the surgical complication and the ulcer recurrence of postoperation,Eye Science2000;16:56-60.     

Effect of FK506 eye-drop combined with keratoplasty on recurrent Mooren's ulcer

OBJECTIVE: To observe the effect of FK506 eye-drop combined with keratoplasty on recurrent Mooren's ulcer. METHODS: 9 cases (15 eyes) of recurrent Mooren's ulcer were treated with topical FK506 eye-drop combined with keratoplasty. Of the 15 eyes, two of Mooren's ulcer smaller than half circle of the limbus were treated with 0.1% FK506 eye-drop. Among the other 13 eyes of the ulcer larger than half the circle of the limbus, 12 eyes were treated with excision of conjunctiva combined with lamellar keratoplasty. One eye with a central corneal perforation was treated with penetrating keratoplasty. FK506 eye-drop 0.1% was given to the 13 operated eyes after the re-epithelialization of the cornea. The effect of FK506 on recurrent Mooren's ulcer was observed. Measurements of FK506 in surgically resected cornea and conjunctiva, and aqueous humor of the operated eyes were performed using enzyme immunoassay procedure. Twelve cases of recurrent Mooren's ulcer treated with lamellar keratoplasty combined with topical 0.1% dexamethasone eye-drop were taken as control. RESULTS: After application of 0.1% FK506 eye-drop, concentrations of 30 - 350 ng/g of FK506 were found in the cornea and conjunctiva, and no FK506 was measured in the aqueous humor. Nine cases (15 eyes) of recurrent Mooren's ulcer were all cured and no recurrence was observed during the follow-up time of 12 - 17 months. The vision of 5 eyes was improved more than 2 lines after the treatment. Seven eyes of Mooren's ulcer in the control group recurred. CONCLUSION: 0.1% FK506 eye-drop combined with keratoplasty is an effective treatment for recurrent Mooren's ulcer.     

0.01%次氯酸局部滴眼治疗细菌性角膜溃疡的临床分析

目的：评估0.01%次氯酸在细菌性角膜溃疡治疗中的作用。

方法：选取2018-08/12在徐州医科大学附属医院眼科就诊的细菌性角膜溃疡患者共60例60眼,随机分为2组,常规治疗组给予左氧氟沙星滴眼液治疗30例30眼,联合用药组在常规治疗的基础上加用0.01%次氯酸水溶液局部滴眼,观察比较两组患者的治疗效果。

结果：联合用药组溃疡愈合时间明显短于常规治疗组(P=0.005),但两组治愈率(P=0.643)、最佳矫正视力(P=0.787)无差异。两组患者出现虹膜睫状体炎发生率无差异(P=0.643)。两组均未出现角膜穿孔、角膜新生血管等并发症,联合用药组患者使用0.01%次氯酸滴眼无明显角膜刺激症状。

结论：0.01%次氯酸局部滴眼能加快细菌性角膜溃疡的愈合速度,且无严重并发症出现。     

Autologous serum application in the treatment of Mooren's ulcer

BACKGROUND: Mooren's ulcer is a peripheral corneal ulceration of presumed autoimmune aetiology. Its clinical course and eventual prognosis is variable and usually these ulcers respond poorly to conventional therapy. HISTORY AND SIGNS: A 67-year-old male was referred to our hospital for a painful, red and tearing left eye after receiving debris. Slit-lamp examination revealed a 3.2 x 2.1 mm peripheral corneal ulcer, a diffuse thinning of the lateral limbus (between 3 o'clock and 5 o'clock) and some endothelial precipitates. The conjunctiva was severely congested. In the anterior chamber, cells (++) and fibrin were found. THERAPY AND OUTCOME: We introduced an antibiotic, corticosteroid and cyclosporin therapy to treat the marginal corneal deficit caused by Mooren's ulcer. The patient did not respond to the initial treatment, but re-epithelialisation occurred and the corneal deficit improved after the introduction of autologous serum eye drops. CONCLUSION: Autologous serum seems to be an effective supplementary therapy in Mooren's ulcer.     

真菌性角膜病变的两种药物治疗疗效对比分析

目的 通过真菌性角膜溃疡应用那他霉素和氟康唑治疗的对照研究,研究那他霉素与氟康唑在真菌性角膜溃疡的治疗作用.方法 对24例24眼确诊真菌性角膜溃疡患者随机分为A、B两组,每组12例,分别用那他霉素眼液及氟康唑眼液进行治疗.结果 A组（那他霉素组）12眼治愈9眼,有效10眼,无效2眼,有效率83％;B组（氟康唑组）12眼,治愈4眼,有效8眼,无效4眼,有效率66％;两组有效率比较,差异无统计学意义（χ2=1.587,P＞0.05）;那他霉素组治愈率75％明显高于氟康唑组33％,差异有统计学意义（χ2=5.048,P＜0.05）;结论 那他霉素对真菌性角膜溃疡具有较好的治疗作用,优于氟康唑.     

Effect of Topical FK506 Used alone or Combined with Keratoplasty on Patients with Recurrent Mooren''''s Corneal Ulcer

PURPOSE: To evaluate the efficacy of topical 0.1% FK506 used alone or combined with keratoplasty on patients with recurrent Mooren's ulcer. METHODS: This is a retrospective interventional consecutive case series. Nine patients (15 eyes) with recurrent Mooren's ulcer were treated with topical 0.1% FK506 alone or combined with keratoplasty. Two eyes with ulcers involving less than half the corneal limbus were treated with topical 0.1% FK506. Of the other 13 eyes with ulcers involving more than half the limbus, twelve were treated with excision of the ulcer and adjacent conjunctiva combined with lamellar keratoplasty. One eye with a central impending corneal perforation was treated with penetrating keratoplasty. Topical 0.1% FK506 was given post-operatively to all thirteen eyes after re-epithelia-lisation of the cornea. FK506 levels in the surgically resected cornea and conjunctiva of the operated eyes were measured using enzyme immunoassay procedures. Twelve patients (17 eyes) with recurrent Mooren's ulcer treated with lamellar keratoplasty combined with topical 0.1% dexamethasone were taken as the control. The main measure of the outcome was the recurrence of Mooren's ulcer in the patients. RESULTS: Nine patients (15 eyes) with recurrent Mooren's ulcer were all successfully treated. Vision in 5 eyes improved by two lines or better after treatment. No recurrence was observed during the follow up period of 12 to 22 months. After topical application of 0.1% FK506, concentrations of 30 to approximately 350 ng/g of FK506 were found in the cornea and conjunctiva. Seven eyes of Mooren' s ulcer in the control group recurred during the follow up period. CONCLUSION: Topical 0.1% FK506 used alone or combined with keratoplasty is a safe and effective therapy for patients with recurrent Mooren's ulcer.