糖皮质激素联合羊膜移植治疗严重边缘溃疡性角膜炎的临床研究  

Treatment of severe marginal ulcerative keratitis by glucocorticoids combined with amniotic membrane transplantation

作　　者：贾艳妮 王敬亭 王欣 杨杨 高华 史伟云 Jia Yanni;Wang Jingting;Wang Xin;Yang Yang;Gao Hua;Shi Weiyun(Eye Institute of Shandong First Medical University,Eye Hospital of Shandong First Medical University(Shandong Eye Hospital),State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Eye Diseases,School of Ophthalmology,Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属眼科研究所、山东第一医科大学附属眼科医院(山东省眼科医院)山东省眼部疾病重点实验室-省部共建国家重点实验室培育基地、山东第一医科大学眼科学院,济南250021

出　　处：《中华眼科杂志》2025年第2期125-130,共6页Chinese Journal of Ophthalmology

摘　　要：目的探讨糖皮质激素联合羊膜移植治疗严重边缘溃疡性角膜炎的临床效果。方法回顾性病例系列研究。收集2017年10月至2022年5月于山东第一医科大学附属眼科医院接受糖皮质激素联合羊膜移植治疗的边缘溃疡性角膜炎患者资料10例(10只眼),其中男性6例,女性4例;平均年龄61.3岁。所有患者均接受了角膜刮片、细菌培养、真菌培养及共聚焦显微镜检查,排除了细菌、真菌及阿米巴感染。主要指标包括视力、眼压、角膜溃疡愈合情况和基质水肿消退情况。结果术后随访1~18个月。患者术后视力均较术前显著提高。10例患者中有5例血免疫指标部分异常。对于内皮面有脓性渗出物附着的患者,术前前节相干光层析成像术检查显示内皮面有脓性渗出物,术中通过前房冲洗分离取出内皮面的脓性渗出膜。术后1~2周角膜溃疡愈合,角膜荧光素染色阴性。1个月角膜基质水肿完全消退。7~10 d表层大羊膜均自溶或脱落,内层羊膜在溃疡面愈合前一直紧贴溃疡面,随角膜溃疡面缩小而缩小,溃疡周围上皮细胞增生,逐渐爬行至溃疡面的小羊膜表面,覆盖角膜溃疡面,溃疡深层的纤维组织和羊膜融合,共同填充溃疡组织缺损区。结论采用糖皮质激素联合羊膜移植治疗的严重边缘溃疡性角膜炎患者,在术后视力提升和角膜溃疡愈合方面表现较好的效果。Objective To explore the clinical effectiveness of glucocorticoids combined with amniotic membrane transplantation in the treatment of severe marginal ulcerative keratitis.MethodsA retrospective case series study was conducted.Data from 10 patients(10 eyes)with marginal ulcerative keratitis who received glucocorticoid administration combined with amniotic membrane transplantation at the Eye Hospital of Shandong First Medical University from October 2017 to May 2022 were collected.There were 6 males and 4 females with an average age of 61.3 years.All patients underwent corneal scraping,bacterial culture,fungal culture,and confocal microscopy examination to exclude bacterial,fungal,and Acanthamoeba infections.The main indicators included visual acuity,intraocular pressure,corneal ulcer healing,and resolution of stromal edema.ResultsThe follow-up after surgery ranged from 1 to 18 months.Postoperative visual acuity in all patients was significantly improved compared to preoperative levels.Among the 10 patients,5 had partial abnormalities in blood immune indicators.For patients with purulent exudates attaching to the endothelial surface as shown on anterior segment optical coherence tomography,anterior chamber irrigation was performed to remove the exudates during surgery.Corneal ulcers healed within 1 to 2 weeks postoperatively,with negative corneal fluorescein stainings.Stromal edema completely resolved within 1 month.The superficial large amniotic membrane autolyzed or fell off within 7 to 10 days,while the inner amniotic membrane remained closely attached to the ulcer surface until the ulcer healed,shrinking as the ulcer surface decreased.Epithelial cells around the ulcer proliferated and gradually crawled to the surface of the small amniotic membrane on the ulcer surface,covering the corneal ulcer surface.The deep fibrous tissue of the ulcer and the amniotic membrane fused,filling the defect area of the ulcer tissue together.ConclusionPatients with severe marginal ulcerative keratitis treated by glucocorticoid ad

关 键 词：角膜溃疡 糖皮质激素类 羊膜 移植 临床研究 

分 类 号：R772.21[医药卫生—眼科]