瘢痕性类天疱疮角膜病变手术治疗  

Surgical treatment of corneal complications in patients with ocular cicatriciai pemphigoid

作　　者：鲍连云[1] 朱丹丹[1] 李一壮[1] 

机构地区：[1]南京大学医学院附属鼓楼医院南京宁益眼科中心,210008

出　　处：《眼科》2008年第5期342-345,共4页Ophthalmology in China

摘　　要：目的观察眼瘢痕性类天疱疮(OCP)行羊膜移植和穿透性角膜移植术(PKP)后的效果。设计回顾性病例系列。研究对象OCP患者3例(4眼)。方法2例(3眼)患者为三级睑球粘连,术前视力HM/5cm～HM/10cm,行睑球粘连分离联合羊膜移植,术后放置绷带性角膜接触镜;另外1例(1跟)因并发角膜溃疡伴穿孔,行PKP,供体为甘油冷冻保存的角膜,观察术后角膜、结膜愈合情况。主要指标视力,角膜、结膜愈合情况。结果羊膜移植2例(3眼)患者术后1个月羊膜逐步吸收,2例(2眼)手术1年后视力0.04～0.05,中央角膜上皮化良好,二级睑球粘连,角膜缘新生血管减少。PKP后3周植片融解严重,1个月后行全角膜移植联合眼前节切除,再次发生植片融解,眼内容物流失而眼球萎缩。结论部分眼表功能不全的OCP患者睑球粘连分离联合羊膜移植对减轻睑球粘连、提高视力有一定意义;由于多种不利因素影响,穿透性角膜移植治疗OCP并发穿孔性角膜溃疡效果不良。Objective To observe the outcome of patients with ocular cicatricial pemphigoid （OCP） after amniotic membrane grafting or penetrating keratoplasty. Design Retrospective, noncomparative case series. Participants 3 consecutive OCP patients （4 eyes）, were included. Methods For 3 patients （4 eyes） in this study, preoperative visual acuity was from HM/5 cm to HM/10 cm. The symblepharon （grade Ⅲ） of 2 patients （3 eyes） were detached and amniotic membrane was transplanted, and bandage contact lens were used till 2 months after operations. The other patient （1 eye） was undergone penetrating keratoplasty with glycerol-cryopreserved cornea because of corneal ulcer and perforation. Main Outcome Measures Visual acuity, recovering of conjunctiva and cornea. Results Amniotic membrane dissolved about 1 month after operation in 2 patients （3 eyes）. Symblepharon changed from grade Ⅲ to grade Ⅱ, visual acuity increased to 0.04-0.05, central corneal epithelium was regenerated significantly, and a little new vessel appeared at corneal limbus in 2 patients （2 eyes）. The graft deliquesced in the patient with penetrating keratoplasty at 20 days after operation and undergone penetrating keratoplasty again after 1 month. In this patient, the graft molten induced the ocular contents run-off and became eyeball atrophy eventually. Conclusion Our small sample study shows that the symblepharon detachment and amniotic membrane transplantation is effective for improving visual acuity in OCP with ocular surface dysfunction. However, because of various factors, penetrating keratoplasty is ineffective for OCP with perforating corneal ulcer.

关 键 词：眼瘢痕性类天疱疮 羊膜移植术 穿透性角膜移植术 

分 类 号：R779.6[医药卫生—眼科]