角膜绷带镜对生物工程角膜移植术后的临床治疗作用  

The clinical effect of corneal bandage lens on bioengineered cornea

作　　者：郝兆芹[1] 马强[1] 王小东[1] 高伟[1] HAO Zhaoqin;MA Qiang;WANG Xiaodong;GAO Wei(Department of Ophthalmology,the First Hospital of Xi'an,Shanxi Ophthalmological Institute, Xi'an 710002,China)

机构地区：[1]西安市第一医院眼科陕西省眼科研究所

出　　处：《实用医学杂志》2019年第18期2900-2904,共5页The Journal of Practical Medicine

基　　金：陕西省科技计划项目(编号:2014D46)

摘　　要：目的观察角膜绷带镜对生物工程角膜移植术后的临床治疗作用。方法收集我院2017年1月至2018年6月住院并使用生物工程角膜进行板层角膜移植手术治疗的感染性角膜溃疡患者30例30眼的临床资料,随机分为A、B两组,各15例。A组角膜上皮愈合后给予戴角膜绷带镜联合滴眼液点眼治疗,2周更换1次,术后3个月拆线后停用。B组患者不戴角膜绷带镜,药物治疗同A组。观察生物工程角膜移植术后角膜植片上皮化时间,比较术后第1、2、3、4周两组角膜植片水肿程度,比较术后第1、2、3个月两组角膜植片上皮完整性和泪膜破裂时间(breakup time of tear film,BUT),比较两组角膜植片水肿消退时间和术后3个月两组角膜植片存活率。结果术后3~5 d角膜植片上皮化,2~4周植片水肿消退。A组患者术后第2~3周角膜植片水肿消退,B组患者第3~4周角膜植片水肿消退,时间长于A组(P <0.001),术后第2~3周A组角膜植片水肿程度明显轻于B组(第2周P=0.002,第3周P <0.001)。术后第1、2、3个月时A组患者角膜荧光素染色评分均低于B组(均P <0.001),BUT时长高于B组(P=0.009、0.002、0.33)。A组患者中1例未按时复诊戴角膜绷带镜近5周,继发细菌感染,退出研究,术后3个月A组植片存活率93.3%(14/15);B组患者有2例1个月后出现角膜上皮无菌性缺损,另有1例术后2个月出现角膜溶解,3例均退出研究,术后3个月B组植片存活率80.0%(12/15),与A组相比差异无统计学意义(P=0.283)。结论生物工程角膜上皮化后戴角膜绷带镜可加速角膜植片水肿消退,保护角膜上皮完整性,维持眼表泪液稳定,有利于维护眼表微环境健康,对生物工程角膜术后角膜植片修复有明显促进作用。Objective To observe the clinical effect of corneal bandage lens on bioengineered cornea after keratoplasty. Methods The clinical data of 30 cases(30 eyes)of infectious corneal ulcer treated by Lamellarkeratoplasty with bioengineered cornea in our hospital from Jan. 2017 to Jun. 2018 were collected. The patients were randomly divided into group A(n = 15)and group B(n = 15). Patients in group A were treated with corneal bandage lens combined with eye drops after corneal epithelial healing. The corneal bandage lens was replaced once every two weeks until the suture was removed at 3 month after surgery. The patients in group B did not wear corneal bandage lens,while the drug treatment was set the same as group A. The corneal epithelialization time after bioengineered cornea keratoplasty was observed for all the patients. The degree of corneal graft edema was compared between the two groups at 1 week,2 week,3 week and 4 week after operation. The epithelial integrity and the breakup time(BUT)of tear film were compared between the two groups at 1 month,2 month and 3 month after operation. The regression time of corneal graft edema and the corneal graft survival rate at 3 month after surgery were compared between the two groups. Results The corneal grafts were epithelized at 3 to 5 days after surgery,and the edema of the grafts disappeared at 2 to 4 weeks after operation. The corneal graft edema disappeared at 2 to 3 weeks after operation in group A and 3 to 4 weeks in group B,and the time was longer than that in group A(P < 0.001). The degree of corneal graft edema in group A was significantly lighter than that in group B at 2 to 3 weeks after operation(P = 0.002 at week 2,P < 0.001 at week 3). The corneal fluorescein staining score of group A was significantly lower than that of group B at 1 month,2 month and 3 month after operation(all P < 0.001). BUT of group A was significantly longer than that of group B at 1 month,2 month and 3 month after operation(P = 0.009,0.002,0.33). One patient in group A withdrew from the

关 键 词：生物工程角膜 板层角膜移植 角膜绷带镜 泪膜破裂时间 角膜植片上皮化 

分 类 号：R779.65[医药卫生—眼科]