棘阿米巴性角膜炎的手术治疗  

Keratoplasty for acanthamoeba keratitis

作　　者：邹留河[1] 吕岚[1] 王荣光[1] 李航[1] 

机构地区：[1]首都医科大学附属北京同仁眼科中心,北京100730

出　　处：《眼科》2004年第6期336-338,共3页Ophthalmology in China

摘　　要：目的 :回顾性分析 2 0例棘阿米巴性角膜溃疡行角膜移植术的疗效 ,确定其手术适应证及手术疗效。方法 :2 0例患者中男性 12例 ,女性 8例 ,年龄 13～ 4 6岁。病因为戴角膜塑型镜 (OK镜 )者 10例 ,戴接触镜者 6例 ,角膜外伤者 4例。手术指征及手术方法 :临床药物治疗无效 ,且角膜病变区逐渐扩大并加深 ,有穿孔危险者。 2 0例患者中 17例采用板层角膜移植术 ,3例因病变较深而行穿透角膜移植术。术后患者仍局部滴用抗阿米巴药物 1～ 3个月。结果 :2 0例患者角膜病变均得到控制。 5例患者术后再次行穿透角膜移植术 ,术后裸眼视力为 0 3～ 0 6。 8例板层植片透明者视力为 0 0 5～ 0 4。未行穿透角膜移植术者 ,由于板层植片大量新生血管长入 ,需再次行板层角膜移植术联合角膜缘干细胞移植术。结论 :棘阿米巴性角膜溃疡药物治疗疗程长 ,难购药品 ,容易延误病情。对病变难以控制者 ,手术治疗为其有效的治疗方法。Objective:To determine the surgical indications and effects for acanthamoeba corneal ulcer.Methods:20 patients (12 males and 8 females,aged 13～46 years) with acanthamoeba corneal ulcer were treated with keratoplasty.The pathogenic factors included orthokeratology(OK lens)(10 cases),contact lens (6 cases),corneal trauma(4 cases).As the condition could not be controlled with clinical medical therapy,and the lesions were enlarged and deepened,even had the risk to perforate keratoplasty was done.17 patients out of 20 had lamellar keratoplasty,while the other 3 patients had penetrating keratoplasty because of the ulcer were deeper.All cases were topically applied anti-ameoba drugs 1～3 months after surgery.Results:All 20 patients’ condition was controlled.5 patients were undertaken penetrating keratoplasty after the former lamellar keratoplasty.Their postoperative vision was 0.3～0.6(uncorrected).In 8 patients with clear lamellar grafts the visions were 0.05～0.4.In those patients who had only done lamellar instead of penetrating keratoplasty need to be performed lamellar keratoplasty again with limbal stem cell transplantation,because there were dense neovascular in the lamellar grafts.Conclusion:It requires a long time to cure acantameoba corneal ulcer with drugs and it is also difficult to buy available commercially medicines in market.So to the cases with acanthameoba corneal ulcer which was not easy to be controlled,surgical treatment was an effective method.

关 键 词：角膜炎 棘阿米巴 角膜移植 角膜炎/外科学 

分 类 号：R779.6[医药卫生—眼科]