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。

Treatment of bullous keratopathy by corneal intralamellar therno cauterization combined with radiotomy of corneal nerve and patch grafting of amniotic membrane.

Objective To observe the clinical effect of corneal intralamellar thermo cauterization combined with radiotomy of corneal nerve and patch grafting of amniotic membrane to treat bullous keratopathy. Methods Twenty-eight cases (28 eyes) of bullous keratopathy with obvious pain and poor vision were selected, including 16 cases after cataract surgery combined with intraocular lens implantation, 3 cases after cataract surgery, 3 cases after cataract surgery combined with anti-glaucoma surgery,2 cases after anti-glaucoma surgery, 1 case with absolute stage of glaucoma, 2 cases after ocular injury, 1 case after vitrectomy. They were all performed with corneal intralamellar thermo cauterization combined with radiotomy of corneal nerve and patch grafting of amniotic membrane. All cases were followed up for 6～32 months after operation. Results The symptoms of pain disappeared in 25 cases, relieved in 3 cases. The visual acuity was improved in 8 cases, no improved in 20 cases. Amniotic membrane was absorbed or desquamated at 5-45 days postoperatively. Corneal bulla disappeared in 26 cases and area of bulla was reduced in 2 cases. Edema of corneal stroma was also decreased in 28 cases. Following up for 6 to 32 months, there was no recurrence of symptoms or bulla and no occurrence of complications. Conclusions Corneal intralamellar thermo cauterization combined with radiotomy of corneal nerve and patch grafting of amniotic membrane is effective to alleviated clinical symptom of bullous keratopathy with poor visual function.