病灶板层切除联合多层羊膜移植及绷带镜治疗基质坏死型单疱病毒角膜溃疡  

Lamellar keratectomy combined with multilayer amniotic membrane transplantation and bandage contact lens for necrotizing HSK

作　　者：董贺[1] 王佼佼[1] 张蕊[1] 于亮[1] 崔林 靳琳 于春晶 梁巍 纪莉莉 牟亚男 张巧思 崔中华[1] 张立军[1] Dong He; Wang Jiaojiao; Zhang Rui; Yu Liang; Cui Lin; Jin Lin; Yu Chunjing; Liang Wei; Ji Lili; Mu Yanan; Zhang Qiaosi; Cui Zhonghua; Zhang Lijun(Department of Ophthalmology, Third People＇ s Hospital of Dalian, Affiliated Hospital of Dalian Medical University, Dalian 116031, China)

机构地区：[1]大连医科大学附属大连市笫三人民医院眼科,大连116031

出　　处：《中国实用眼科杂志》2017年第10期986-990,共5页Chinese Journal of Practical Ophthalmology

基　　金：大连市科技计划（指导类）项目（2015E21SF010）

摘　　要：目的评价角膜病灶板层切除术联合多层羊膜移植及角膜绷带镜治疗基质坏死型单纯疱疹病毒角膜溃疡的临床效果。方法回顾性分析。对2016年1-12月在大连医科大学附属大连市第三人民医院眼科确诊基质坏死型单疱病毒角膜溃疡15例15只眼，采用角膜病灶板层切除联合多层羊膜移植、角膜绷带镜和药物治疗。随访时间至少6个月，观察术后角膜修复情况。结果14只眼在7-30 d内炎症治愈，应用绷带镜角膜上皮在7-21 d内完全修复，外层覆盖羊膜在7-10 d脱落，内层羊膜与角膜基质融合，其上角膜上皮细胞覆盖，视力有不同程度提高，角膜混浊分级1级2只眼，2级7只眼，3级5只眼，除外角膜变薄及1只眼角膜后膨隆无其他并发症。1只眼角膜自溶穿孔合并视网膜脱离行眼球摘除。结论角膜病灶板层切除术联合多层羊膜移植及角膜绷带镜治疗基质坏死型单纯疱疹病毒角膜溃疡可以保存眼球及有效视力，避免角膜移植手术或急性炎症期的角膜移植手术。ObjectiveTo evaluate the clinical effectiveness of application of lamellar keratectomy combined with multilayer amniotic membrane transplantation and bandage contact lens, systemic antiviral and topical corticosteroid therapy to eyes with necrotizing HSK.MethodsData were retrospectively analyzed of 15 patients （15 eyes） with necrotizing HSK that could not heal or aggravated after 7 days of antiviral therapy. Lamellar keratectomy combined with multilayer amniotic membrane transplantation and bandage contact lens wear with local corticosteroid eye drops and systemic antiviral medications were performed on the eyes; follow up was at least 6 months for postoperative cornea.ResultsFourteen eyes achieved inflammation remission within 7 to 30 days. Corneal epithelium healing time under bandage contact lens was within 7 and 21 days. Vision was improved. Numbers of eyes with corneal haze grading as 1, 2 and 3 were 2, 7 and 5 in each group respectively. No other complications were observed except thinning of cornea and keratectasia in 1 eye. Enucleation was performed in 1 eye that had corneal self-resolution and perforation combined with retinal detachment.ConclusionsIn this observational study, early lamellar keratectomy combined with multilayer amniotic membrane transplantation and bandage contact lens, systemic antiviral and topical corticosteroid therapy to eyes with necrotizing HSK may preserve the intact eye and effective vision, in addition it avoids corneal transplantation at all or at least delayed corneal transplantation during the acute phase of inflammation.

关 键 词：病灶板层切除 绷带镜 羊膜移植 单疱病毒角膜溃疡 

分 类 号：R772.21[医药卫生—眼科]