春季角结膜炎角膜缘病变的手术治疗  

Surgical treatment of vernal keratoconjunctivitis with pathological changes at the limbus

作　　者：姜冬玲[1] 张明昌[1] 胡燕华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院眼科,武汉430022

出　　处：《临床眼科杂志》2006年第3期235-237,共3页Journal of Clinical Ophthalmology

摘　　要：目的评估角膜缘病变区球结膜环形切除联合羊膜移植治疗角膜缘病变为主的春季角结膜炎的临床效果。方法对10例(20只眼)以角膜缘病变为特征的春季角结膜炎患者,采用角膜缘病变区球结膜环形切除联合羊膜移植的方法予以治疗。术后随访5～21月,观察其症状、体征的改变及复发情况。结果手术后,患者症状明显改善：痒感、分泌物多、异物感等症状基本消失；手术后1周内,畏光、流泪明显,后逐渐减轻,手术1月后基本消失。角膜缘黄褐色或污红色胶样结节手术清除后在随访期间未复发；角膜上皮点状着色(11只眼)、角膜渍疡(3只眼)于手术后1周内愈合,染色转阴,且在随访期间未复发；术后球结膜充血逐渐减轻,19只眼手术1月后充血基本消失,且角膜缘羊膜移植区的球结膜较正常偏白,但有1只眼术后球结膜充血间断反复约5月并伴有轻度痒感,药物可减轻该眼的痒和充血,但多次出现反复。所有病例随访期间未发现严重的并发症。结论角膜缘病变区球结膜切除联合羊膜移植治疗角膜缘病变为主的春季角结膜炎治疗是有效安全的。Objective To evaluate the efficacy and safety of annular bubble conjunctival excision combined with amniotic membrane transplantation（AMT） for vernal keratoconjunctivitis（VKC） with gelatinous swellings（papillae） at the limbus. Methods 20 eyes （10 patients ） with VKC, characterized by gelatinous swellings（papillae） at the limbus, underwent annular bubble conjunctival excision associated with AMT. The follow up ranged 5 - 21months. Results after operation, symptoms subsided remarkably ： itching, discharge, and foreign body sensation were almost disappear; photophobia and tearing were obviously in the first week after surgery, but gradually alleviated, and almost disappear 1 month postoperative. snuff color gelatinous protuberance at the hmbus were cleaned away by operation and did not recur during the follow up. Corneal superficial punctuate keratitis （11 eyes）and corneal ulcers （3 eyes）healed during the first week after surgery and did not recur. Postoperative conjunctival congestion was gradually lessened, and in 19 eyes it could not be noted 1 month after surgery, and the conjunctiva around the limbus, where AMT was performed, was whiter than the normal . But conjunctival congestion in 1 eye lasted for about 5 mouths accompanied with a httle of itch, and this eye was treated by eyedrops with improvement but recurrence. No severe comphcations had been seen during the follow-up. Cconclusion annular bubble conjunctival excision combined with amniotic membrane transplantation is an effective and safe method for the treatment of vernal keratoconjunctivitis with gelatinous swellings（papillae） at the hmbus.

关 键 词：羊膜移植 角膜缘 春季角结膜炎 

分 类 号：R779.6[医药卫生—眼科]