角膜板层剥离瓣下烧灼术治疗大泡性角膜病变

白内障术后发生持续性角膜水肿即大疱性角膜病变，是白内障术后比较严重的并发症，根本原因是角膜内皮受损失代偿。超声乳化术、现代囊外术、非超小术、针吸术都可以发生。引起角膜疱性病变的原因很多，如术前已出现角膜内皮病变或细胞密度低下；术中过度损伤角膜内皮；不良眼内灌注液；玻璃体、虹膜或晶体囊膜粘连于手术切口；术中使用高浓度的乙酰胆碱、肾上腺素所致的化学损伤；[第一段]     

角膜层间分离术治疗大泡性角膜病变报告

由各种机械、物理、化学以及生物因素所引起的角膜内皮损伤,均可致大泡性角膜病变的发生.不但严重影响视力,而且由于反复上皮脱落,给患者带来剧烈的刺激症状.关于本病的治疗,目前尚无理想的方法.亲水性角膜接触镜只能暂缓解症状,板层或穿透性角膜移植虽能有效地治疗角膜大泡,但材料匮乏,且费用较高.     

穿透性角膜移植术治疗大泡性角膜病变

目的 探讨穿透性角膜移植术治疗大泡性角膜病变的临床疗效。方法 对17例17眼大泡性角膜病变施行穿透性角膜移植术或穿透性角膜移植联合手术。随访观察2～43个月并进行了回顾性分析。结果 角膜植片透明12例,半透明3例,植片混浊2例。其中4例在术后2周～21个月发生角膜免疫排斥反应,经保守治疗后控制。全部患者术后眼部刺激症状消失。除1例术前视力无光感,术后视力无变化外,其余病例术后视力均有不同程度提高。结论 穿透性角膜移植术或穿透性角膜移植联合手术,是解除眼部疼痛刺激症状、提高视力的首选而有效的方法。     

角膜层间烧灼术治疗大泡性角膜病变

我们对２例白内障人工晶体植入术后致角膜内皮失代偿,发生大泡性角膜病变患者行角膜层间烧灼术,取得了良好效果,现报告如下。例１吴某某女６０岁８５年两眼曾行抗青光眼滤过手术,９４年１２月行左白内障摘除、后房人工晶体植入术。术后因角膜内皮失代偿,视力不提高,...     

全角膜板层切开分离术治疗大泡性角膜病变

近年来 ,大泡性角膜病变 (ｂｕｌｌｏｕｓｋｅｒａｔｏｔｈｙ ,ＢＫ)的发病率随着人工晶体植入手术的普及而呈上升趋势〔1〕。目前对ＢＫ的有效治疗方法如“穿透性角膜移植”、“角膜层间羊膜植入”等手术 ,因移植材料、排异反应等问题而受到一定限制。我们自 1996年 2月— 2 0 0 1年 8月间施行“全角膜板层切开分离术”治疗ＢＫ 2 4例 ,疗效良好 ,现报告如下。一般临床资料 :本组患者为 1997 2～ 2 0 0 1 8住院手术的大泡性角膜病变病例 ,其中男 11例 ,女 13例 ;年龄 5 4～ 81岁 ,平均 6 3岁 ,均为单眼发病。超声乳化白内障摘除人工晶体植…     

羊膜移植治疗大泡性角膜病变

目的：研究羊膜移植治疗大泡性角膜病变的疗效。方法：对15例（15只眼）大泡性角膜病变患者采用羊膜移植治疗。其中无晶状体眼5例,人工晶状体眼5例,有晶状体眼者3例,角膜移植片失败者2例,结果：随访期3－12个月,治疗后1－3天内症状解除者13例（86．67％）,症状减轻者2例,氖患者角膜上皮缺损在3－4周内愈合。结论：羊膜移植能有效地控制大泡性角膜病变的症状,促进上皮愈合,且安全、简便,易行,具有很大的发展前途。     

角膜层间烧灼术治疗大泡性角膜病变

目的 探讨角膜层间烧灼术对大泡性角膜病变的治疗效果.方法 对7例(7眼)大泡性角膜病变施行角膜层间烧灼术.结果 6眼角膜大泡完全消失,角膜无水肿,症状完全改善,1眼仍发生局部的大泡性病变,重复行角膜层间烧灼术后获得良好效果.结论 对于不能实行穿透性角膜移植术或角膜内皮移植术的大泡性角膜病变,视力严重受损,角膜刺激症状明显者,角膜层间烧灼术是一种有效的方法.     

软性角膜接触镜治疗大泡性角膜病变

目的：评价软性角膜接触镜（soft contact lens,SCL)在大泡性角膜病变治疗中的作用。方法：17例大泡性角膜病变患者配戴SCI,每月更换1次,随访观察患者临床症状是否改善及有无并发症出现。结果：17例患者随访2－22mo,临床症状都得到一定改善,无明显并发症出现。结论SCL能明显改善大泡性角膜病变患者的临床症状,提高患者的生活质量。     

角膜层间分离术治疗大泡性角膜病变

目的 临床观察不可逆性角膜病变行角膜层间分离术的疗效。方法 对10例(10眼)角膜大泡病变患者行角膜层间分离术。结果 随访时间为2年，10眼角膜大泡消失，症状完全缓解，患者仍保留了原来残存视力。结论 该手术是在缺乏角膜材料时，治疗角膜大泡病变比较理想的一种简单、安全、实用的手术方法。     

角膜板层烧灼术治疗大泡性角膜病变

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。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。     

角膜前基质穿刺术治疗大泡性角膜病变

目的 探索角膜前基质穿刺术治疗大泡性角膜病变的效果。方法 对１１例大泡性角膜病变的病因进行分析。并用角膜前基质穿刺术方法进行治疗。结果 １１例病例,随访３ｍｏ,症状均获缓解,角膜大泡清除。结论 对机械性或物理性因素所致的大泡性角膜病变患者,采用角膜前基质穿刺术治疗。获得了较好的治疗效果。     

Use of amniotic membrane transplantation for treating bullous keratopathy

One of the complications of cataract surgery is bullous keratopathy, which is the result of decompensation of the corneal endothelium. The clinical signs are manifested in stromal and epithelial edema with bullae producing. The amniotic membrane, which is taken from the placenta of young mothers during the caesarean section, may have beneficial influence on the process of healing the corneal structure. The study aimed to evaluate effectiveness of bullous keratopathy treatment using amniotic membrane transplantation, as an alternative method of treatment after cataract surgery. MATERIAL AND METHODS: The amniotic membrane transplantation was performed in 18 eyes of 18 patients (10 females and 8 males), aged 62 to 85 with the bullous keratopathy. After removing the pathologically changed epithelium, the amniotic membrane was covered on cornea in local anesthesia, using interrupted sutures 10.0 nylon. A therapeutic contact lens were applied. Control examinations were performed 3, 6 and 12 weeks after the operation. The best corrected visual acuity was evaluated. The local state was investigated using slitbiomocroscopy and confocal microscopy. RESULTS: In all the patients' regression of subjective complaints was observed (pain, light sensitivity and tearing). In 12 cases improvement of visual acuity was achieved. The evaluation of corneas in slit biomicroscopy revealed greater clarity and less corneal edema. On confocal microscopy, decrease in blurred collagen fibers and background illumination were observed. The epithelium contained cystic structures (blisters) in 6 cases only. The endothelial cells were pleomorphic and polymegathic. CONCLUSION: The amniotic membrane transplantation is an effective method of treatment for bullous keratopathy and has beneficial influence on the process of corneal healing and the improvement of visual acuity and diminish subjective symptoms.     

角膜基质针刺联合羊膜移植术治疗大泡性角膜病变

目的：探讨施行角膜基质针刺联合羊膜移植术治疗大泡性角膜病变（bullous keratopathy,BK）的临床疗效。方法：对35例35眼大泡性角膜病变者施行角膜基质针刺联合羊膜移植术,所有患者术前、术后均行前节OCT、角膜地形图、角膜知觉、共焦显微镜检查。观察患者术后眼部症状、大泡复发情况、角膜知觉改变、角膜厚度变化、角膜各层组织结构变化。结果：角膜基质针刺联合羊膜移植术后随访6～18mo。32例（91%）均在术后第1d疼痛感消失,并在随访期间未再出现疼痛,另外3例（9%）疼痛感减轻并在3d后消失。9例（26%）术后角膜上皮在1wk内愈合,21例（60%）在2wk内愈合,5例（14%）在3wk内愈合。随访期间BK无复发,2例（6%）在术后3,4wk在周边区域见少量微小水泡,无自觉症状,随时间延长未见加重。所有患者无新生血管发生,角膜表面光滑。30例（86%）移植的羊膜于术后2mo变薄,部分溶解吸收,3mo时肉眼基本不见羊膜。34例（97%）视力无改变,1例（3%）由光感到手动/眼前。30例（86%）术后2mo角膜知觉减退,下降幅度为20±7mm,所有患者角膜厚度均增加,由术前的788±35μm,增至940±43μm,术后12mo,角膜厚度增至1 060±27μm。共焦显微镜结果：术后3mo,角膜基底膜下三叉神经纤维数量密度降低,浅基质层基质细胞成纤维化,深基质层更加疏松、细胞肿胀明显,内皮细胞数量较术前减少且肿胀更加明显。结论：角膜基质针刺联合羊膜移植术能有效控制BK的症状,防止BK的复发,尤其是对症状明显,视功能差的患者是简单、安全、实用的方法。     

The bandage lens in bullous keratopathy

One of the most common indications for the fitting of therapeutic contact lenses is bullous keratopathy, a painful condition often iatrogenic in origin and more usually encountered in elderly patients. A retrospective study of 30 patients fitted with therapeutic lenses for the condition and followed up for at least a year showed that the symptoms of bullous keratopathy were reduced in most cases. There was a higher incidence of suppurative keratitis (13 per cent) than has been reported in previous series. The prescribing of prophylactic antibiotics was haphazard in the series, and the authors suggest further study is needed to determine their precise role.     

自体血浆角膜基质内注射治疗大泡性角膜病变

目的 观察自体血浆角膜基质内注射治疗大泡性角膜病变的临床疗效.方法 对31例大泡性角膜病变患者施行自体血浆基质内注射,术后长期跟踪随访6～48个月,平均24个月.结果 注射后72h,血浆完全吸收,角膜水肿减轻,角膜上皮光滑.所有病例的无显著临床角膜刺激症状,角膜大泡消失.保留了原来的残存视力.结论 大泡性角膜病变能通过自体血浆角膜基质内注射的方法得到有效治疗,特别是在没有活性角膜材料供给的情况下,或者对于视功能差的患者和(或)患眼目前尚不具备角膜移植条件的患者,它是简单、安全、实用的方法.     

Phototherapeutic keratectomy for bullous keratopathy.

AIMS--This study was designed to investigate the therapeutic potential of excimer laser for recurrent painful erosions in patients not suited to treatment with penetrating keratoplasty. METHODS--Phototherapeutic keratectomy (PTK) with the excimer laser was performed prospectively on a series of 13 eyes of 12 patients with recurrent corneal erosions in connection with bullous keratopathy of varied aetiology. The main complaint of the patients before the treatment was frequent attacks of pain. The patients selected either refused corneal grafting or could not for a variety of reasons expect to profit visually from an operation. The treatment was performed with the MEL 60 Aesculap Meditec excimer laser using either a spot mode (five cases), a scanning mode (three cases), or a combination of both (five cases). RESULTS--All patients responded well to the treatment, and the pain subsided after a couple of weeks. In five cases (38.5%) a second treatment was necessary because of persistent pain, which was, however, much less than before the initial treatment. In four of these five patients small corneal bullae persisted. The visual performance of the seven patients with visual acuity better than 20/200 ameliorated in two cases and remained unchanged in four cases. One patient lost two Snellen lines after the laser treatment for terminal glaucoma. The mean follow up was 14.1 months (range 1-28 months). No complications were seen so far. CONCLUSION--It was concluded that PTK is a very promising and effective outpatient treatment for patients with bullous keratopathy. This therapeutic approach is not thought to have been described before.