羊膜移植治疗春季角结膜炎的角膜缘病变

目的:评估角膜缘病变区球结膜环形切除联合羊膜移植治疗角膜缘病变为主的春季角结膜炎的临床效果。方法:对 10 例(20 眼)以角膜缘病变为特征的春季角结膜炎患者,采用角膜缘病变区球结膜环形切除联合羊膜移植的方法予以治疗。术后随访 5～21mo,观察其症状、体征的改变及复发情况。结果:手术后,患者症状明显改善:痒感、分泌物多、异物感等症状基本消失;手术后 1wk 内,畏光、流泪明显,后逐渐减轻,手术 1mo 后基本消失。角膜缘黄褐色或污红色胶样结节手术清除后在随访期间未复发;角膜上皮点状着色(11 眼),角膜溃疡(3 眼)于手术后 1wk 内愈合染色转阴且在随访期间未复发;术后球结膜充血逐渐减轻,19 眼手术1mo 后充血基本消失,且角膜缘羊膜移植区的球结膜较正常偏白,但有 1 眼术后球结膜充血间断反复约 5mo 并伴有轻度痒感,药物可减轻该眼的痒和充血,但多次出现反复。所有病例随访期间未发现严重的并发症。结论:角膜缘病变区球结膜切除联合羊膜移植治疗角膜缘病变为主的春季角结膜炎是有效安全的,但应严格选择手术对象。

Amniotic membrane transplantation for limbal pathological changes of vernal keratoconjunctivitis

AIM: To evaluate the efficacy and safety of annular bubble conjunctival excision combining with amniotic membrane transplantation(AMT) for vernal keratoconjunctivitis(VKC) with gelatinous swellings(papillae) at the limbus.METHODS: Twenty eyes(10 patients) with VKC, were characterized by gelatinous swellings(papillae) at limbus and were underwent annular bubble conjunctival excision associated with AMT. The follow up ranged 5-21months.RESULTS: After operation, the symptoms were subsided remarkably: itching,discharge and foreign body sensation were almost disappear; photophobia and tearing were obvious in the first week after surgery, but were gradually alleviated, and almost disappear after one month of postoperative.Yellow-brown or filthy red gelatinous protuberances at limbus were cleaned away by operation and did not recur during the follow up. Corneal superficial punctuate keratitis(11 eyes) and corneal ulcers(3 eyes) were healed during the first week after surgery and did not recur. Conjunctival congestion was gradually lessened after surgery, which could not be noted 1months after surgery in 19 eyes, and the conjunctiva around the limbus, where AMT was performed, was whiter than the normal. But conjunctival congestion in 1 eye lasted for about 5mon accompanying with a little of itch, and this eye was treated with eyedrops with improvement but recurrence. No severe complications had been seen during the follow up.CONCLUSION: Annular bubble conjunctival excision combining with amniotic membrane transplantation is an effective and safe method for the treatment of vernal keratoconjunctivitis with gelatinous swellings (papillae) at limbus. But the candidates must be chosen with discretion.