重症角膜结膜干燥症自体颌下腺移植术后眼表长期追踪  

Long-term investigation on ocular surface changes after autologous submandibular gland transplantation for severe keratoconjunctivitis sicca

作　　者：吴珺[1] 邹留河[1] 潘志强[1] 吕岚[1] 朱正宏[2] 张雷[3] 蔡志刚[3] 俞光岩[3] 

机构地区：[1]首都医科大学附属北京同仁医院眼科中心,北京100730 [2]北京同仁医院口腔科,100730 [3]北京大学口腔医学院颌面外科,100081

出　　处：《眼科研究》2008年第5期362-365,共4页Chinese Ophthalmic Research

基　　金：国家自然科学基金资助(30171016);卫生部科研基金(wkz-2000-1-09)资助

摘　　要：目的观察自体颌下腺移植治疗重症角膜结膜干燥症术后的长期眼表状态变化，评估颌下腺移植术后板层角膜移植的临床疗效。方法分析50例颌下腺移植成功患者的临床资料，检查视力、满意度、人工泪液使用、泪液分泌、眼表荧光染色、泪膜破裂时间、泪液镜和结膜印迹细胞学，观察眼表结构的变化。对其中7例颌下腺移植术后患者行板层角膜移植术。结果所有患者随访1～3年，角膜结膜干燥症状消失，视力提高两行或以上者48例，主观评定满意45例。术后1年停用人工泪液及自体颌下腺移植术后超过3年的患者结膜出现杯状细胞。行板层角膜移植术患者随访3年，3例植片透明，4例混浊。结论自体颌下腺移植治疗重症角膜结膜干燥症能改善泪液缺乏，稳定眼表；联合角膜移植是治疗重症角膜结膜干燥症的有效方法。Objective In previous study, our surgery outcome of autologous vascularized submandibular gland （SMG） transplantation for severe keratoconjunctivitis sicca was varified to be successful and effective. The present study was to observe the ocular surface changes after SMG transplantation for severe keratoconjunctivitis sicca and evaluate the keratoplasty occurrence after autologous SMG transplantation. Methods A retrospective study was performed in 50 patients with a successful SMG transplantation during the period from July 1999 to July 2006. The visual acuity, degree of discomfort, usage of pharmaceutical tear substltutes,Schirmer I test, fluorescein staining, tear film break-up time （BUT）, DR-1 tear interferometry and conjunctiva impression cytology were investigated to assess the ocular surface changes at different time. Seven patients were treated with lamellar keratoplasty and followed up for three years. Results All 50 patients were followed up for 1 to 3 years. The disappearence of dry eye symptoms and signs and improvement of vision were observed in 48 cases （96%） , and the subjective satisfaction was increased in 45 cases （ 90% ）. The topically utilization of artificial tear substitution was ended 1 year later following the transplantation in all the patients. The goblet cells appeared and increased by impression cytology at 3 years after autologous vascularized SMG transplantation in comparison with the preoperative result. Lamellar keratoplasty was performed on 7 patients with the autologous SMG transplantation, showing 3 clear and 4 opacitied grafts during the 3-year follow-up period. Conclusion Microvascular autologous SMG transplantation for severe keratoconjuctivitis sicca can improve the ocular surface lubrication and tears membrane stabilization in absolute tear deficiency patients in both short and long term basis. The combination of autologous SMG transplantation with lamellar keratoplasty is an effective procedure for treating severe keratoconjunctivitis sicca.

关 键 词：角结膜干燥症 颌下腺移植 眼表状态 板层角膜移植术 

分 类 号：R779.6[医药卫生—眼科]