春季角结膜炎巨大乳头手术治疗的临床分析  

Preliminary report of surgical treatment of vernal keratoconjunctivitis with giant papillae J

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：《中华眼科杂志》2007年第1期14-17,共4页Chinese Journal of Ophthalmology

摘　　要：目的探讨上睑乳头切除、冷冻联合羊膜移植治疗有巨大乳头的春季角结膜炎的临床效果。方法对8例（16只眼）以上睑结膜巨大乳头为特征的药物治疗无效的春季角结膜炎患者，采用上睑结膜巨大乳头切除，-70℃二氧化碳冷冻上睑结膜表面，并移植单层羊膜于上睑表面的方法予以治疗。术后随访3～22个月，观察患者症状、体征的改变及并发症等情况。结果术后1周内，盾性角膜溃疡、角膜上皮点片状着色全部愈合，且在随访期间未复发。14只眼治愈，眼刺激症状手术后1个月基本消失，巨大乳头无复发、未出现睑内翻、倒睫等并发症，但上睑结膜血管纹理欠清，有少许瘢痕。2只眼巨大乳头复发，但范围较术前缩小，眼刺激症状也较术前减轻；其中1只眼经药物治疗后好转；另1只眼再次手术，用5-氟尿嘧啶棉片浸润上睑后行羊膜移植，术后随访9个月未复发。结论切除加冷冻联合羊膜移植可能是治疗难治的有巨大乳头的春季角结膜炎的安全有效的方法，但是应严格选择手术适应证。Objective To evaluate the efficacy and safety of excision and cryotherapy combine with amniotic membrane transplantation （AMT） for the treatment of vernal keratoconjunctivitis （VKC） with giant papillae （GP）. Methods Eight patients （16 eyes） with VKC, characterized by GP on the upper tarsal conjunctiva, refractory to medical treatment, underwent excision and cryotherapy associated with AMT. The follow up period ranged 3-22 months. Results Corneal shield ulcers and superficial punctuate keratitis healed during the first week after the surgery and did not recur. Fourteen eyes were symptom free and without GP one month after surgery. No ectropion, trichiasis and other complications were noted. The blood vessels of upper tarsal conjunctiva could not be seen clearly, a small amount of conjunctival scar was observed. Recurrence of GP was observed in 2 eyes, with reduced area and lessened irritation symptom as compared with preoperative status. Among them, one eye was treated by cyclosporine eyedrops with improvement. The other eye did not improve, and underwent secondary surgery （a cotton patch soaked in fluorouracil was applied on the upper eyelid after excision and cryotherapy）. Nine months after the treatment, the patient had no symptoms and GP did not recur. Conclusions Excision and cryotherapy combine with AMT may be an effective and safe method for the treatment of refractory VKC with GP. But the candidates for surgical treatment should be chosen carefully.

关 键 词：羊膜 移植 眼外科手术 结膜炎 变应性 

分 类 号：R686[医药卫生—骨科学]