异体巩膜联合多层羊膜移植治疗翼状胬肉术后无菌性角巩膜融解的疗效探讨  

Therapeutic efficacy of variant sclera transplantation combing multilayered amnion transplantation for sterility cornea and sclera melting after pterygium surgery

作　　者：伍志琴[1] 杨燕宁[1] 袁静[1] 蔡明高[1] 邢怡桥[1] 

机构地区：[1]武汉大学人民医院眼科武汉大学医学院眼科研究所,武汉430060

出　　处：《中国实用眼科杂志》2009年第3期266-269,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨翼状胬肉切除术后无菌性角膜、巩膜融解的原因及异体巩膜移植联合多层羊膜移植治疗此病的疗效。方法收集4例于外院行单纯翼状胬肉切除术后发生无菌性角膜、巩膜融解而转至我院的患者的临床资料，进行回顾性分析。取巩膜坏死组织进行涂片、微生物培养，并对这4例患者进行血清学检查。采用异体巩膜移植联合多层羊膜移植的手术方式，并辅以环孢霉素A眼液、重组人表皮生长因子眼液、人工泪液点眼。结果4例患者细菌及真菌培养均未见微生物生长，1例患者类风湿因子高达139IU／ml，3例患者患有干眼症。异体巩膜联合多层羊膜移植术后8～15d羊膜开始融解，角膜上皮完全修复；7-11d可见血管长人异体巩膜组织，约45d巩膜坏死区愈合。结论全身胶原血管性疾病及手术刺激等所致的免疫反应可能是翼状胬肉切除术后产生无菌性角巩膜融解的主要因素；异体巩膜移植联合羊膜移植可有效地控制巩膜融解并促进角膜修复。Objective In this study,the causes of sterility cornea and selera melting following ptery- gium surgery and the therapeutic effect of variant sclera transplantation combing multilayered amnion trans- plantation for it were approached.Methods The clinical data of 4 patients with sterility cornea and sclera melt- ing after simple pterygium surgery were collected and retrospectively analyzed.Take the necrotic sclera tissue to smear and culture, and carry out serological examination.The 4 eyes were treated with variant sclera transplan- tation combining multilayered amnion transplantation and given adjunctive therapy with cyelosporine A, rhEGF and artificial tears.Results No bacterial and fungal were found and there were no evidence of inflammation in the 4 patients.RF was 139IU/ml in One patient.3 patients presented dry eye.The amnion began melting at 8-15d after variant sclera transplantation combing multilayered amnion transplantation, and the cornea gradually ep- ithelized leaving an opacitas.At 7-1 1 d, the neovascular has begun to grow into the variant sclera tissue.About 45d, the necrotic sclera has healed.Conclusions The immunoreaction caused by systemic immunity and oper- ative may be the main cause of sterility cornea and sclera melting after pterygium surgery.The variant sclera transplantation combining multilayered amnion transplantation was helpful to treat the sclera melting and promoted the corneal epithelization.

关 键 词：翼状胬肉切除术 巩膜融解 角膜融解 异体巩膜移植联合羊膜移植 

分 类 号：R473.77[医药卫生—护理学] R777.1[医药卫生—临床医学]