共焦显微镜观察真菌性角膜溃疡多层羊膜移植术后的转归  

Outcome observation of multi-amniotic membrane transplantation for fungal corneal ulcer by confocal microscope

作　　者：程燕[1] 吴洁[1] 高伟[1] 朱海峰[1] 朱秀萍[1] 

机构地区：[1]西安市第一医院眼科,西安市眼科医院,陕西省西安市710002

出　　处：《眼科新进展》2012年第10期972-975,共4页Recent Advances in Ophthalmology

摘　　要：目的应用共焦显微镜观察真菌性角膜溃疡多层羊膜移植术后不同随访时期的变化,以评价该种手术方法的临床价值及探讨术后羊膜的转归。方法选取经两性霉素B脂质体联合局部清创的方法控制感染,但上皮长期不愈的真菌性角膜溃疡患者32例(32眼),其中22例行多层羊膜移植术作为本研究的治疗组,10例患者拒绝手术,继续给予抗真菌药物治疗,作为对照组。所有研究对象角膜溃疡深度≤1/2角膜厚度,角膜溃疡直径≤6mm。术前所有患眼经角膜刮片均证实有真菌感染(包括丝状真菌和酵母样菌)。对治疗组患者于术后2周、1个月、3个月及6个月行共焦显微镜检查,同时对照组亦行共焦显微镜检查,观察角膜上皮愈合时间,溃疡深层愈合情况,并于术后6个月行患眼UBM检查,测量角膜厚度。结果治疗组术后1个月溃疡表面完全愈合,其外层羊膜片于术后10～14d溶解,原病变区角膜创面上皮化,至术后3个月时深层羊膜部分吸收,瘢痕形成;术后6个月患者原病变区角膜半透明,表面光滑。随访期间真菌无复发。共焦显微镜检查示,术后2周角膜表层的羊膜细胞溶解,被角膜上皮细胞取代,上皮下可见大量树突细胞;随之上皮下树突状细胞逐渐减少,深层羊膜逐渐溶解,但至术后6个月仍可见羊膜基底膜,上皮下神经纤维未见恢复;术后6个月角膜测厚与正常角膜厚度无显著差异。药物治疗对照组可见感染控制后1个月溃疡表面上皮化,但可见上皮点状缺损,上皮下树突状细胞随病程延长未见明显减少;6个月时角膜厚度明显变薄,与正常角膜厚度具有显著差异。结论多层羊膜移植是治疗轻度和中度真菌性角膜溃疡的一种有效的方法,共焦显微镜为活体状态下观察深层羊膜转归及溃疡愈合提供了有力的手段。Objective To observe the changes at different time of multilayer amniotic membrane transplantation for fungal corneal ulcer by confocal microscope to evaluate its clinicalvalue,and discuss the outcome of postoperative amniotic membrane.Methods The method of amphotericin B liposome and local debridement were used to control infection,but the epithelium could not long-term healing in 32 cases （32 eyes） with fungal corneal ulcer patients,in which 22 cases received multilayer amniotic membrane transplantation and set as treatment group,10 cases refused surgery and the antifungal treatment was continued and set as control group.The depth of corneal ulcers in all cases was equal to or less than half of corneal thickness,and the corneal ulcer diameter was equal to or less than 6 mm.All eyes in the preoperative corneal scraping were confirmed fungal infections （including filamentous fungi and yeast-like fungus）.The confocal microscopy examination was performed at postoperative 1 month,3 months and 6 months in treatment group and control group.The corneal epithelial healing time and deep ulcer healing were observed,UBM examination was made at postoperative 6 months to measure the corneal thickness.Results The ulcer surface was completely healed at postoperative one month in treatment group,and its outer layer of amniotic membrane was dissolved from postoperative 10 days to 14 days.The primary corneal wound was epithelialized.At postoperative 3 months the deep amniotic membrane partially absorbed with scar formation.At postoperative 6 months,the original cornea lesions were transparent,and the surfaces were smooth.During the follow-up,no fungi recurrence appeared.The confocal microscopy showed the amniotic cells above the corneal surface were dissolved and substituted by corneal epithelial cells,many dendritic cells under the epithelium were seen.Furthermore,the dendritic cells were gradually reduced,deep amnion was gradually dissolved,but the amniotic basement membrane was still seen at postoperative 6 months,the

关 键 词：多层羊膜 羊膜移植 真菌性角膜溃疡 共焦显微镜 

分 类 号：R772.21[医药卫生—眼科]