角膜移植联合结膜瓣遮盖术治疗干燥综合征继发深层角膜溃疡患者的临床疗效  

Keratoplasty combined with conjunctival flap covering in the treatment of deep corneal ulcers secondary to Sjögren’s syndrome

作　　者：王珂 李凤洁 仲晓维 史伟云 王婷 WANG Ke;LI Fengjie;ZHONG Xiaowei;SHI Weiyun;WANG Ting(Qingdao University Medical College,Qingdao 266000,Shandong Province,China;Eye Hospital of Shandong First Medical University,State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Shandong Eye Institute,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250000,Shandong Province,China)

机构地区：[1]青岛大学医学部,山东省青岛市266000 [2]山东第一医科大学(山东省医学科学院),山东省眼科研究所,山东省眼科学重点实验室-省部共建国家重点实验室培育基地,山东第一医科大学附属眼科医院,山东省济南市250000

出　　处：《眼科新进展》2020年第8期740-743,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金重点项目(编号81530027);山东省自然科学基金项目(编号ZR2019MH135)。

摘　　要：目的探讨角膜移植联合结膜瓣遮盖术治疗干燥综合征(SS)继发深层角膜溃疡患者的临床疗效。方法本研究为回顾性临床分析,收集2008年1月至2019年11月在我院风湿免疫科确诊SS后并于我科检查发现继发深层角膜溃疡的患者16例17眼。SS的诊断和治疗采用2002年SS国际分类(诊断)标准和中华医学会风湿病学分会发布的SS诊断及治疗指南。根据角膜移植手术是否联合结膜瓣遮盖将患者分为单纯角膜移植组(7例7眼)与联合结膜瓣遮盖组(9例10眼)。所有患者手术结束后都进行了睑裂缝合。检测并记录各组患者基础泪液分泌、手术前后溃疡和穿孔及视力改变情况。结果术前,基础泪液分泌试验结果显示,16例患者32眼术前泪液分泌均缺乏;单纯角膜移植组患者基础泪液分泌试验结果为(0.83±0.68)mm,联合结膜瓣遮盖组为(0.50±0.62)mm,两组差异无统计学意义(P=0.226)。术前,单纯角膜移植组患者溃疡直径为(2.50±0.83)mm,联合结膜瓣遮盖组为(3.00±0.91)mm,两组溃疡直径差异无统计学意义(P=0.270);单纯角膜移植组溃疡穿孔1例,联合结膜瓣遮盖组穿孔2例,两组溃疡穿孔率,差异无统计学意义(P>0.05)。术后,单纯角膜移植组溃疡复发5例(71.43%),联合结膜瓣遮盖组0例,两组溃疡复发率差异有统计学意义(P<0.05)。术后,单纯角膜移植组患者视力0.05~0.10者2例2眼较术前视力增加,但因溃疡复发再次手术视力下降者5例5眼。术后,联合结膜瓣遮盖组患者视力0.10~0.20者6例6眼,0.20~0.30者2例2眼;视力增加8例8眼(80%),无变化1例2眼(20%)。结论角膜移植联合结膜瓣遮盖术治疗SS继发深层角膜溃疡能更好地提高患者视力,降低溃疡复发率。Objective To investigate the clinical outcomes of keratoplasty combined with conjunctival flap covering in the treatment of deep corneal ulcers secondary to Sjögren’s syndrome(SS).Methods This study is a retrospective clinical analysis of 16 patients(17 eyes)who were diagnosed with SS in the Department of Rheumatology and Immunology and then found deep corneal ulcers secondary to SS in our hospital from January 2008 to November 2019.The diagnosis and treatment of SS were based on the classification criteria for SS issued in 2002 and the SS diagnosis and treatment guidelines issued by Chinese Rheumatology Association.The patients were divided into two groups according to whether they received keratoplasty combined with conjunctival flap covering operation keratoplasty group(7 patients 7 eyes)and keratoplastycombined with conjunctival flap covering group(9 patients 10 eyes).All patients underwent tarsorrhaphy at the same time.The basic lacrimal secretion as well as the ulcers,ulcer perforation and the vision changes before and after operation were detected and recorded.Results Before operations,the results of Schirmer test showed that 16 patients(32 eyes)lacked basic lacrimal secretion the result of thekeratoplasty group was(0.83±0.68)mm and the result of the keratoplasty combined with conjunctival flap covering group was(0.50±0.62)mm.There was no significant difference between the two groups(P=0.226).Preoperatively,the diameter of ulcers in the keratoplasty group was(2.50±0.83)mm,and that in thekeratoplasty combined with conjunctival flap covering group was(3.00±0.91)mm,with no significant difference(P=0.270).There was 1 patient(1 eye)in the keratoplasty group and 2 patients(2 eyes)in thekeratoplasty combined with conjunctival flap covering group suffered ulcer perforation.There was no significant difference in the rate of ulcer perforation between the two groups(P>0.05).After operations,5 patients(71.43%)in the keratoplasty group had ulcer recurrence and 0 in the other group.The difference between the two

关 键 词：干燥综合征 角膜移植术 结膜瓣遮盖术 角膜溃疡 

分 类 号：R772[医药卫生—眼科]