继发性淀粉样角膜变性的临床观察

目的：观察倒睫相关的继发性淀粉样角膜变性的临床特征。方法：回顾性系列病例研究。收集2014年1 月至2015年12 月期间在山东省眼科研究所青岛眼科医院接受治疗的倒睫相关的继发性淀粉样角膜变性患者的临床资料。对患者的年龄、性别、病史、临床表现、诊断方法、治疗和组织病理学检查结果进行总结分析。通过光学相干断层扫描（OCT）和超声生物显微镜（UBM）评估病变累及角膜的深度。结果：共纳入7 例患者，其中男5 例，女2 例，年龄11～86 岁。所有患者均有倒睫病史。角膜病变表现为单眼发病、角膜表面有新生物隆起，新生物具有表面欠平整、边界清晰和形状不规则等特征。OCT和UBM结果显示所有病例中病变深度均未累及后弹力层。有3 例患者接受板层角膜移植术；1 例患者行角膜病变切除联合羊膜覆盖术；3 例患者行睑内翻及倒睫矫正术，因病灶对视力无明显影响，未行角膜病变切除术。组织病理学检查结果显示，角膜上皮下方有大量无定形的嗜酸性物质沉积，刚果红染色阳性，在偏振光下呈现“苹果绿”双折射现象。结论：与倒睫相关的继发性淀粉样角膜变性的临床特点主要表现为患眼同时存在倒睫及角膜新生物2 种病变，且新生物的发病位置与倒睫刺激角膜的位置一致；角膜病变特点为倒睫刺激角膜的部位有新生物隆起，新生物表面欠平整，边界清晰、形状不规则。

Clinical Observations of Secondary Corneal Amyloidosis

Objective: To report clinical observations of secondary corneal amyloidosis (SCA) related to trichiasis diagnosed and treated at Qingdao Eye Hospital. Methods: In this retrospective series of case study, medical records of 7 patients with trichiasis-related SCA from January 2014 to December 2015 were reviewed. Patient age, gender, history of disease, clinical manifestation, diagnosis methods, treatments, and histopathological results were analyzed. The depth of amyloid deposition in the corneal stroma was examined with optical coherence tomography (OCT) or ultrasound biomicroscopy (UBM). Results: The patients were 5 males and 2 females, age 11-86 years. All patients had a history of trichiasis. The common characteristics of the corneal lesions were a unilateral and well-circumscribed mass, with an irregular and mulberry-like surface, protuberant from the corneal surface at the position irritated by trichiasis. OCT orUBM showed Descemet's membrane was uninvolved in all cases. Lamellar keratoplasties were performed for 3 patients, and 1 patient underwent lesion excision combined with amniotic membrane covering. For the other 3 patients, the entropion and trichiasis were corrected with surgeries, but the mass was not resected because visual acuity was not obviously affected. Amorphous eosinophilic materials, with positive Congo red stain and apple-green birefringence beneath the epithelium were revealed by histopathology.Conclusions: SCA related to trichiasis typically presents a unilateral, well-circumscribed, irregular, and mulberry-like mass protuberant from the corneal surface at the position irritated by trichiasis.