角膜层间灼烙联合羊膜移植治疗疼痛性大泡性角膜病变

目的：：观察角膜层间灼烙联合羊膜移植治疗疼痛性大泡性角膜病变的手术疗效。方法：选取疼痛性大泡性角膜病( PBK )患者156例156眼(均为单眼),行角膜层间灼烙联合羊膜移植术,术后随访2~3mo,观察患者术眼疼痛症状、角膜上皮水泡、异物感、术后并发症等指标。结果：疼痛症状全部消失,角膜上皮不再出现水泡130例(83.3%);患者剧烈眼疼消失,但偶有异物感等不适,角膜上皮偶有小水泡24例(15.4%);术后2wk内角膜基质发生溶解,再行结膜瓣覆盖后治愈2例(1.3%)。结论：角膜层间灼烙联合羊膜移植术能解除98.7%的PBK患者的痛苦且手术操作简单,值得提倡。     

嵌入法羊膜移植治疗大泡性角膜病变

目的：评价嵌入法羊膜移植治疗大泡性角膜病变的临床效果.方法：对16例（16眼）大泡性角膜病变患者施行嵌入法羊膜移植治疗.结果：羊膜移植术后随访3-6mo,角膜上皮10d内均完全修复,14例疼痛完全消失.2例周边角膜局限小泡,4例术后视力提高.结论：嵌入法羊膜移植治疗大泡性角膜病变是有效可行的.     

角膜基质层烧烙联合羊膜移植治疗大泡性角膜病变

目的探讨角膜基质层烧烙联合羊膜移植治疗大泡性角膜病变（BK）的临床疗效。方法对9例（9只眼）大泡性角膜病变的患者行角膜基质层烧烙联合羊膜移植,其中白内障联合人工晶状体植入术后5例,抗青光眼术后3例,角膜穿通伤1例。结果术后眼部刺激症状、角膜上皮大泡均于1周内消退,角膜基质水肿7～10d消失。术后随访3～24个月,均未发现BK复发及并发症的发生。结论对于症状明显、病情顽固、难以恢复有效视力且不具备角膜移植条件的BK患者,角膜基质层烧烙联合羊膜移植可有效控制BK的症状,防止BK的复发,是治疗BK可供选择的有效方法。     

新鲜羊膜移植治疗大泡性角膜病变的临床分析

目的:观察羊膜移植治疗大泡性角膜病变的临床疗效,探讨大泡性角膜病变有效可行的治疗方法。方法:回顾分析经羊膜移植进行治疗的18例18眼大泡性角膜病变,对18例患者术后眼部刺激症状消失时间、大泡消失例数、羊膜溶解时间、角膜上皮完全修复时间、视力改善状况进行分析评价。结果:大泡性角膜病变患者18例中,10例在术后3d内疼痛消失,18例大泡消失,15d内移植的新鲜羊膜全部溶解,无1例出现排斥反应,15d内角膜上皮完全修复。结论:羊膜移植治疗大泡性角膜病变是取材方便、费用低廉、效果可靠的治疗方法。     

角膜板层烧烙联合羊膜移植治疗大泡性角膜病变

目的:研究角膜板层烧烙联合羊膜移植治疗大泡性角膜病变(bullous keratopathy,BK)的疗效.方法:对12例(12眼)BK患者采用角膜板层烧烙联合羊膜移植治疗,其中绝对期青光眼7例,人工晶状体眼4例,角膜穿孔伤1例.结果:患者12例术后眼部疼痛等刺激症状均消失,随访3～48 mo均未发现BK复发及并发症的发生.结论:角膜板层烧烙联合羊膜移植可有效地控制BK的症状,防止BK的复发,是治疗BK可供选择的有效方法.     

新鲜羊膜移植治疗大泡性角膜病变的临床观察

目的:观察新鲜羊膜移植治疗大泡性角膜病变的临床疗效,探讨大泡性角膜病变有效可行的治疗方法。方法:回顾分析经新鲜羊膜移植进行治疗的13例13眼大泡性角膜病变,其中人工晶状体眼10例,绝对期青光眼2例,外伤性晶状体前脱位1例。对13例患者术后眼部刺激症状消失时间、大泡消失例数、羊膜溶解时间、角膜上皮完全修复时间、视力改善状况进行分析评价,同时与报告中大泡性角膜病变的其他治疗方法上述指标比较。结果:13例大泡性角膜病变患者中10例在术后3d内疼痛消失,13例大泡消失,14d内移植的新鲜羊膜全部溶解,无1例出现排斥反应,14d内角膜上皮完全修复,与报告中除角膜移植外的视力改善率有显著性差异(P<0.05)外,与其余同类方法相关指标比较无统计学差异。结论:新鲜羊膜移植治疗大泡性角膜病变是取材方便、费用低廉、效果可靠的治疗方法。     

羊膜移植治疗大泡性角膜病变

目的 :探讨施行羊膜移植术治疗大泡性角膜病变的临床效果。方法 :对 11例 ( 11眼 )大泡性角膜病变患者施行羊膜移植术。结果 :羊膜移植后随访 1～ 7个月间 ,术前难以忍受疼痛的 11例中 10例 ( 91% )术后疼痛消失 ,1例疼痛减轻。有 4例 ( 36 % )术后视力提高 ,9例 ( 82 % )角膜上皮在 5周内迅速愈合 ,另 2例角膜大泡局限于小区域。结论 :羊膜移植术为大泡性角膜病变的有效方法 ,与继往其他方法比较具有明显优越性     

自体板层角膜转位联合层间烧灼及羊膜移植术治疗大泡性角膜病变

目的 探讨自体板层角膜转位联合层间烧灼及羊膜移植术在大泡性角膜病变治疗中的临床效果.方法 选取大泡性角膜病变患者6例(6眼),均有明显刺痛、流泪症状.其中白内障术后3例;白内障术后继发青光眼1例:青光眼术后并发白内障1例:角膜异物取出术后1例.6例患者均行自体板层角膜转位联合层间烧灼及羊膜移植术治疗.结果 6例患者术后眼病等刺激症状基本消失,角膜上皮完整,随访3～12个月均未发现大泡性角膜病变复发及并发症出现,视力有轻度提高.结论 自体板层角膜转位联合层间烧灼及羊膜移植术可有效缓解大泡性角膜病变的症状,是解除视功能不佳的大泡性角膜病变患者临床症状的有效方法.     

新鲜羊膜移植联合治疗性软性角膜接触镜在治疗翼状胬肉中的应用

目的：探讨新鲜羊膜移植联合治疗性软性角膜接触镜在治疗翼状胬肉中的临床效果,并总结其临床价值。

方法：回顾性分析2010-01/2011-06在我院行翼状胬肉切除联合新鲜羊膜移植术患者200例220眼,其中100例110眼联合配戴治疗性软性角膜接触镜(试验组),其余患者作为对照组(100例110眼),并对两组患者术后的临床效果进行比较分析。

结果：对照组术后角膜上皮修复时间为2～7(平均3.8)d,术后随访观察6～18mo,有9眼复发,复发率为8.2%; 试验组术后角膜上皮修复时间为1～5(平均2.5)d,随访观察6～18mo,其中有5眼复发,复发率为4.5%,两组疗效比较,差异有统计学意义(P<0.05)。同时,我们也发现配戴角膜接触镜后术后早期刺激症状明显减轻。

结论：翼状胬肉切除联合羊膜移植并配戴治疗性软性角膜接触镜的术后临床效果明显优于翼状胬肉切除联合新鲜羊膜移植术。配戴治疗性软性角膜接触镜可缩短术后角膜上皮的修复时间,可有效降低翼状胬肉术后的复发率,并且可以在一定程度上缓解术后因角膜上皮缺损而导致的畏光、流泪、异物感及眼痛等术后刺激症状。     

角膜层间灼烙联合羊膜移植治疗大泡性角膜病变

为解除患者痛苦 ,防止大泡性角膜病变的复发 ,我们采用角膜层间灼烙联合羊膜移植治疗本病 ,取得良好效果。现报告如下 :临床资料 :共选择内皮细胞功能严重损伤所致大泡性角膜病变患者 12例 ,男 7例 ,女 5例。年龄 35～ 6 7岁 ,平均5 6 5岁。其中老年性白内障人工晶体术后所致大泡性角膜病变 4例 ,青光眼所致者 3例 ,外伤性白内障术后 1例 ,角膜外伤所致者 3例 ,穿透性角膜移植术后排斥反应所致者 1例。全部患者均伴有剧烈眼痛及畏光流泪等刺激症状 ,全角膜呈灰白色 ,基质水肿增厚 ,上皮大泡形成。其中有 5例患者伴有持续性角膜上皮缺损。视…     

角膜层间晶状体前囊植入联合羊膜移植治疗大泡性角膜病变

目的 探讨角膜层间晶状体前囊植入联合羊膜移植治疗大泡性角膜病变的效果.方法 对内眼手术后大泡性角膜病变11例（11眼）施行角膜层间晶状体前囊植入联合羊膜移植术.术后随诊12个月,观察治疗后疼痛等症状缓解情况、角膜水泡消退、角膜上皮愈合情况,以及有无眼部并发症.结果 11例中,9例术后疼痛症状减轻,6例术后视力提高,8例角膜缺损区3周内愈合.结论 在基层医院缺乏角膜材料的情况下,应用角膜层间晶状体前囊植入联合羊膜移植治疗大泡性角膜病变,可缓解大泡性角膜病患者的痛苦,提高部分患者视力,达到治疗的效果.     

角膜层间烧灼联合错位神经根切断及羊膜覆盖术治疗大泡性角膜病变

目的 观察角膜层间烧灼联合错位角膜神经根切断及羊膜覆盖术治疗大泡性角膜病变的临床疗效。方法 选取有明显眼痛且视功能差的大泡性角膜病变患者28人（28只眼）,其中白内障摘除联合人工晶体植入术后16只眼,单纯白内障摘除术后2只眼,白内障针拨术后1只眼,青光眼白内障联合术后3只眼,青光眼滤过术后2只眼,闭角型青光眼绝对期1只眼,眼外伤2只眼,玻璃体切割术后1只眼。对28只眼均行角膜板层切开,层间烧灼,错位角膜神经根切断及羊膜覆盖术。术后随诊观察6～ 32个月,平均18月。结果 术后28只眼中25只眼(89.3％)术后疼痛感消失,3只眼(10.7％)疼痛明显缓解。术后1月8只眼(28.6％)视力提高,20只眼(71.4％)视力同术前。羊膜于术后5 ～45天脱落或溶解,平均28.8天。 术后26只眼(92.9％)角膜上皮在1月内愈合,角膜大泡完全消失,2只眼(7.1％)角膜大泡范围明显缩小。28只眼角膜基质水肿均减轻。随访6～ 32个月均未发现症状复发,角膜大泡复发或其他并发症出现,患者原有残存视力保留或提高。结论 角膜层间烧灼联合角膜错位神经根切断及羊膜覆盖术是缓解视功能差的大泡性角膜病变患者疼痛症状的有效的手术方法。     

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。     

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.     

羊膜应用于眼表疾病的临床分析

目的探讨羊膜在眼表疾病中应用的适应证及效果。方法回顾2006年5月至2009年5月在我院行羊膜治疗的病例,分析其原发病、手术方式及治疗效果。结果羊膜治疗的患者共81例（87眼）。其中羊膜覆盖术（覆盖全角膜或全部眼球表面）35例（39眼）,羊膜移植术（移植于角膜病灶区）13例（15眼）,羊膜移植联合羊膜覆盖术31例（31眼）,羊膜充填术（填补角膜缺损）2例（2眼）。羊膜覆盖术患者的原发病为单纯疱疹病毒性角膜炎（上皮型）、角膜上皮缺损、化学伤、暴露性角膜炎、神经源性角膜炎及大泡性角膜病变。羊膜移植患者的原发病为睑球粘连、假性胬肉及义眼台脱出;羊膜移植联合羊膜覆盖术患者的原发病为真菌性角膜炎、单纯疱疹病毒性角膜炎（混合型）、细菌性角膜炎、睑球粘连、假性胬肉及蚕蚀性角膜溃疡。羊膜充填术的原发病为角膜穿孔伤。羊膜治疗后均未见免疫排斥现象。结论羊膜具有良好的组织相容性和低免疫原性,可广泛应用于眼表疾病的冶疗。     

Cryopreserved amniotic membrane transplantation for the management of symptomatic bullous keratopathy

Background: To report the results of cryopreserved human amniotic membrane transplantation for the management of symptomatic bullous keratopathy. Methods: Prospective non‐comparative interventional case series study. Consecutive cases with symptomatic bullous keratopathy for more than 12 months not amenable to conservative treatment were managed with amniotic membrane transplantation. They were recruited over a 5‐year period (September 1999 to November 2004) in one referral centre. Only one eye of each patient (the worse affected eye in bilateral cases) was operated. A 360 degree conjunctival peritomy was followed by removal of the diseased corneal epithelium. Amniotic membrane was transplanted over the cornea as a patch and sutured to the free conjunctival edges. Primary outcome measures were ocular pain and epithelial defects; secondary measures were visual acuity and ocular surface inflammation. Results: Four out of 85 recruited cases did not complete the minimum observation of 12 months and were excluded from the study. The mean follow‐up period for the remaining 81 cases was 21 ± 4.2 months (range 14–34 months). Seventy‐one (87.6%) eyes became asymptomatic with healed epithelium, seven required repeated amniotic transplantation and three underwent penetrating keratoplasty. Visual acuity improved in 64 (79%) patients and remained unchanged in 14. No complications were recorded. Conclusions: Amniotic membrane transplantation is an efficient and safe treatment for symptomatic bullous kerato pathy, when penetrating keratoplasty is not available. It has been shown to alleviate pain, promote corneal epithelialization and reduce conjunctival inflammation whereas in some cases it may also improve visual acuity.     

角膜板层错位切开联合羊膜移植治疗大泡性角膜病变

目的探讨一种治疗大泡性角膜病变的新方法。方法对不具备行角膜移植的大泡性角膜病变患者行角膜板层错位切开＋羊膜移植术,观察其疗效。结果本组8例（8只眼）患者行手术治疗后,眼痛、流泪症状消失,角膜上皮修复,缓解了症状,保留了眼球。结论角膜板层错位切开联合羊膜移植对于不具备行角膜移植的大泡性角膜病变患者可有效缓解症状,减轻患者痛苦,且操作简单,值得基层推广。     

Transplantation of amniotic membrane for patients with bullous keratopathy and chemical and thermal burns

The aim of this paper is, to evaluate the efficacy of amniotic membrane transplantation for ocular surface reconstruction in patients with bullous keratopathy and chemical and thermal burns of cornea and conjunctiva. Amniotic membrane is a thin, semitransparent tissue forming an innermost layer of the fetal membrane, which contains a thick basement membrane with a single layer of epithelium and avascular matrix. This transplantation promotes normal conjunctival epithelization while suppressing fibrosis formation. Amniotic membrane transplant may be considered as an alternative method for treating ocular surface reconstruction in patients with thermal and chemical burns. Authors suggest that this method of treatment is not efficient in patients with bullous keratopathy.