角膜前基质微穿刺术联合羊膜移植术治疗大泡性角膜病变疗效观察

目的探讨角膜前基质微穿刺术（ACSM）联合羊膜移植术（AMT）治疗大泡性角膜病变（BK）的疗效。方法13例（13只眼）BK患者为研究对象，男8例，女5例；年龄35～83岁，平均（70．5±15．2）岁，病程2～24个月。其中5例采用单纯AMT，8例采用ACSM联合AMT。观察两组患者移植片溶解时间、治疗前后视力改善情况以及复发等情况。结果单纯AMT组患者术后1～3d疼痛消失，羊膜移植片于术后7～20d溶解或脱落，平均（13±5）d，3周后角膜大泡消失，视力较术前无明显改善，3例复发。ACSM联合AMT组患者术后1～3d疼痛消失，羊膜移植片于术后25～52d溶解或脱落，平均（34±9）d，显著长于单纯AMT组（t=8．32，P〈0．05）。4周后羊膜与角膜上皮下组织融合。视力较术前略有改善。1例复发，但无自觉症状，未再次手术。结论ACSM联合AMT治疗BK较单纯AMT疗效好．值得临床推广。

Curative effect of anterior corneal stromal micropuncture combined with amniotic membrane transplantation therapy on bullous keratopathy

Objective To explore the curative effect of anterior corneal stromal micropuncture(ACSM) combined with amniotic membrane transplantation(AMT) therapy on bullous keratopathy(BK).Methods Thirteen cases(13 eyes) with BK as research object,male 8 cases,female 5 cases;age from 35 to 83 years old,average age was(70.5±15.2) years,duration of disease for 2 to 24 months.Five cases treated with simple AMT,8 cases with ACSM combined with AMT.Graft dissolution time,visual acuity improvement before and after treatment and recurrence were observed in two groups.Results In simple AMT group,pain disappeared after surgery 1 to 3 days,amniotic membrane graft dissolved or fall off after 7 to 20 days,for an average of(13±5) days,corneal bullae disappeared after 3 weeks,visual acuity had no improvement compared with pre-operative,3 cases of recurrence.In ACSM combined with AMT group,pain disappeared after surgery 1 to 3 days,amniotic membrane graft dissolved or fall off after 25 to 52 days,for an average of(34±9) d,longer than simple AMT group significantly.Amniotic membrane and corneal subepithelial tissue fusion after 4 weeks.Visual acuity improved slightly.One case had recurrence,but no self-conscious symptoms,no operation again.Conclusion ACSM combined with AMT have better curative effect compared with simple AMT,deserve clinical expansion.