摘要
目的探讨多层羊膜移植联合抗病毒药物和糖皮质激素治疗基质坏死型单纯疱疹病毒性角膜炎(HSK)的临床疗效。方法选择2003年1月至2004年4月在山东省眼科研究所青岛眼科医院就诊的13例(13只眼)基质坏死型HSK患者,病程为3～22个月,平均15个月。经过系统的局部及全身抗病毒药物治疗1周以上,角膜炎性反应迁延不愈,角膜溃疡有继续扩大或向深基质发展趋势。利用角膜刮片镜检、坏死组织培养或共焦显微镜检查排除细菌或真菌感染,行多层羊膜移植手术,术后联合抗病毒药物和糖皮质激素滴眼液进行治疗。裂隙灯显微镜观察角膜溃疡愈合和基质水肿消退情况,荧光素钠染色观察角膜上皮的愈合情况,共焦显微镜检查角膜上皮和羊膜的转归情况。随访时间3～13个月,平均10个月。结果术后1～3周,13例患者角膜溃疡愈合,荧光素钠染色阴性;术后1个月,角膜基质水肿完全消退。术后7～10d,表层大羊膜均发生自溶或脱落;内层羊膜紧贴角膜溃疡面,并逐渐溶解吸收,最长在位时间达到术后3个月。共焦显微镜检查仍可见羊膜组织结构,其上有扁平的角膜样上皮细胞覆盖。术后3个月时,7例角膜恢复透明,4例形成角膜斑翳,2例形成角膜白斑,眼表恢复稳定。在随访期内13例患者均未见HSK复发。结论多层羊膜移植联合抗病毒药物和糖皮质激素是治疗基质坏死型HSK的一种有效方法。
Objective To evaluate the efficacy of multilayer amniotic membrane transplantation （AMT） combined with antivirus and corticosteroid drug to treat necrotizing herpes simplex stromal keratitis. Methods Thirteen patients （13 eyes ） of necrotizing stromal keratitis were referred to Shandong Eye Institute and Qingdao Eye Hospital between January 2003 and April 2004. The course of disease was 3 - 22 months （mean 15 months）. Corneal inflammation persisted and corneal ulcer progressed despite topical and systemic antiviral treatment for over 1 weeks. Multilayer amniotic membrane transplantation was performed after excluding of bacterial and fungal infection by microbiologic studies including smears and cultures of necrotic corneal tissue and confocal microscope. Topical and systemic antiviral medications were given with adjuvant eortieosteroid eyedrops postoperatively. We investigated the healing of corneal ulcer and improvement of stromal edema with slit lamp biomicroscope, the integrity of corneal defect with fluorescein staining, the migration of healthy corneal epithelial cells and transformation of amniotic membrane with eonfoeal microscopy. All patients were followed up for 3-13 months （ mean 10 months）. Results Corneal ulcer healed within 1-3 weeks postoperatively with negative fluorescein staining. Corneal stromal edema faded away within 1 month. Superficial amniotic membrane patches dissolved or shed on postoperative day 7-10, while the deeper grafts were adhered into the ulcer and fused with the surrounding fibroblasts. One of these grafts remained in situ more than 3 months. Confocal microscope examination indicated fiat epithelial progenitor cells on the surface of residual amniotic membrane. Corneal transparence was achieved in 7 eyes, maeula in 4 eyes and leucoma in 2 eyes 3 months after the operation. No recurrence of necrotizing stromal keratitis was occurred in 13 patients during the follow-up period . Conclusion Multilayer AMT combined with antivirus and corticosteroid treatment is an effective method to treat necrotizing herpes simples stromal keratitis.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2005年第12期1107-1111,共5页
Chinese Journal of Ophthalmology
关键词
羊膜移植
角膜炎
疱疹性
角膜溃疡
Amnion
Transplantation
Keratitis, herpetic
Corncal ulcer
