大植片板层角膜移植治疗重症蚕蚀性角膜溃疡

目的:探讨大植片板层角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。方法:对6例(9眼)术前药物及其他手术治疗无效、病变区累及角膜1/2以上的重症蚕蚀性角膜溃疡的患者,在保留正常角膜后弹力层的基础上,彻底清除病灶,并采用带角膜缘干细胞的大植片板层角膜移植。术后予以10g/L环胞霉素A+皮质类固醇眼液滴眼。结果:术后9眼刺激症状缓解,角巩膜创面光滑,角膜植片透明,愈合良好,视力逐渐提高。经过平均20.6mo随访,眼表保持稳定,未见溃疡复发,除角膜层间新生血管及上皮型排斥反应外,未出现明显并发症。结论:采用新鲜的带环形巩膜瓣的全角膜板层移植术,配合术后长期应用皮质类固醇和免疫抑制剂,是目前治疗复发性蚕蚀性角膜溃疡最有效的手术方法。

Large-diameter lamellar keratoplasty in the treatment of severe mooren's ulcer ophthalmology department

AIM: To evaluate the effect of large-diameter lamellar keratoplasty (LKP) on reconstruction of corneal stroma and epithelium in the treatment of severe Mooren’s ulcer. ·METHODS: Six cases (9 eyes) of severe Mooren’s ulcer were treated with large-diameter LKP. All of them responded poorly to the conventional therapy. More than 6 o’clock positions of limbus before operation were involved. After thorough debridement of the ulcer floor with reserve of normal Descemet’s membrane, large-diameter LKP with limbus stem cell was performed. 10g/L cyelosporine A eyedrops and topical corticosteroids were used postoperatively. ·RESULTS: After operation, subjective symptoms subsided, operation area of cornea and sclera became smooth, cornea became clear, epithelium healed and remained stable, visual acuities were improved. There were no recurrence of corneal ulcer, no other compli-cations except neovascularization and epithelial rejection during the mean 20.6 months follow-up. ·CONCLUSION: Fresh large-diameter LKP with annular sclera lamellar combined with long-term topical corticos-teroids and immune depressor administration is the most effective treatment for recurrent Mooren’s ulcer.