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。

Combined lamellar keratoplasty and amniotic membrane grafting in the treatment of severe Mooren'''' s corneal ulcer

Aim To evaluate the efficacy and safety of lamellar keratoplasty (LKP) combined with cryopreserved human amniotic membrane (AM) grafting for reconstruction of corneal stroma and epithelium in severe Mooren's corneal ulcer. Methods Five cases (5 eyes) of severe Mooren's corneal ulcer were treated with the combined operations. All of them had had a rapidly progressive, painful corneal melting and responded poorly to the conventional therapy. The limbus involved ranged from 6 to 12 (mean, 9.0) o'clock positions. Before operation, all patients had been given topical and systematic steroids. A 5-mm area of conjunctiva and Tenon's fascia at the limbus was removed to bare sclera. After meticulous debridement of the ulcer floor and border area, cauterization was applied over the necrotic area. The ulcer bed was covered with the monolayer AM anchored with a single 10-0 nylon in interrupted sutures around the ulcer area. In the eyes with corneal perforation, the multilayer AM was transplanted as a material to fill the stromal layer. In the eyes with deep corneal ulcer, LKP was performed. After operation, all patients were handled with artificial tears, antibiotic eye drops and topical corti-costeroids. Postoperatively, depth of anterior chamber, speed of reepithelialization, regression of the active inflammatory process, stability of the corneal stromal thickness, recurrence of corneal ulcer, and visual acuity were documented. Reexaminations were made daily during the first seven postoperative days and weekly after that. The observation period ranged from 4 to 15 months (mean, 8.6 months). Results The outcome was satisfactory in all cases. After this procedure, subjective symptoms subsided. Ocular inflammation was reduced markedly. Epithelium healed and remained stable. Neovascularization the was reduced and the ocular became smooth and wet. The LKP graft was smooth and semi-transparent. There was no remarkable vision loss. No complications or recurrence was noted. Conclusion The combined operation is effective for Mooren' s corneal ulcer.