病灶切除联合冷冻及羊膜移植治疗蚕蚀性角膜溃疡的临床研究

目的 探讨应用病灶切除联合冷冻及羊膜移植的方法治疗蚕蚀性角膜溃疡的有效性和安全性.方法 选择2005年1月至2007年5月的蚕蚀性角膜溃疡患者,共12例(14只眼),病程为15 d至2年(平均3.5月).所有患者均行病灶切除联合冷冻及羊膜移植术,术后随访5～24个月,裂隙灯显微镜观察角膜溃疡愈合及羊膜组织转归,荧光素钠染色观察角膜上皮的愈合情况.同时观察并发症及复发情况.结果 眼部疼痛、畏光、流泪等刺激症状明显缓解,表层羊膜于3～7 d开始脱落或自溶吸收,内层羊膜与角膜组织牢固愈合.角膜溃疡在1～3周修复,角膜融解得到控制,角膜厚度增加.14只眼中首次手术9只眼治愈,3只眼好转,治愈及好转率为85.71%,无并发症发生.结论 病灶切除联合冷冻及羊膜移植治疗蚕蚀性角膜溃疡是有效、安全的.

Focal lesion keratectomy combined with cryotheraty and anmiotic membrane transplantation in the management of Mooren's ulcer

Objective To examine the efficacy and safety of focal lesion keratectomy combined with cryotheraty and amniotic membrane transplantation in the treatment of Mooren's ulcer.Methods Twelve patients(14 eyes)with Mooren's ulcer were treated with focal lesion keratectomy combined with cryotheraty and amniotic membrane transplantation between January 2005 and May 2007.The course of diseases was 15 days to 2 years(mean 3.5 mouths),All of them had a rapid progressive and painful periphery corneal ulcer.We investigated the healing of corneal ulcer and transformation of amniotic membrane with slitlamp biomicroscope,the integrity of corneal defect with fluorescein staining,complications and ulcer recurrences were analysed.Results All the cases were followed up for 5 to 24 months after operation of them,symptoms subsided remarkably and immediately in all patients.Superficial anmiotic membrane patches dissolved or shed on postoperative day 7-10,while the deeper grafts were adhered into the ulcer and fused with the surrounding fibroblasts.Corneal ulcer healed within 1-3 weeks postoperatively with negative fluorescein staining,Corneal melts were controlled,the corneal thickness was increased.All but 2 eye remained free of ulcer recurrence,the curative rate was 85.71%.No complication occurred.Conclusion Focal lesion keratectomy combined with cryotheraty and amniotic membrane transplantation is an effective and safe method for the treatment of Mooren's ulcer.