摘要
目的分析蚕蚀性角膜溃疡角膜移植术后复发的主要原因,并探讨术后复发的治疗手段。方法回顾性分析蚕蚀性角膜溃疡行角膜移植术后的30例(30只眼)患者的病例资料(其中外院13例,本院17例),研究复发与眼别、全身免疫因素、术后药物维持治疗之间的关系;据复发溃疡累及角膜植片的面积及深度制定治疗方案。结果共17例复发(56.7%)(其中外院术后复发13例,本院术后复发4例)。复发组中双眼发病者6例(35.3%),未复发组中双眼发病者2例(15.4%)。复发组中7例免疫学指标部分阳性(41.2%),未复发组中6例免疫学指标部分阳性(46.2%)。3例试行药物治疗,无效后改行板层角巩膜移植术联合羊膜移植术(AMT)后治愈。3例复发溃疡浅行AMT,术后1例因未定期复诊溃疡复发行结膜瓣遮盖术后治愈。8例复发溃疡深或范围大行板层角巩膜移植联合AMT,术后2例因未规律药物治疗复发,再次行板层角巩膜移植术治愈。3例复发至植片溃疡穿孔,自体板层角膜组织修补穿孔后,再行板层角巩膜移植联合AMT,随访无复发。结论蚕蚀性角膜溃疡角膜移植术后复发与双眼发病、免疫因素、术后是否规律药物治疗相关。如药物治疗不能治愈该病,再次板层角巩膜移植联合羊膜移植术是治疗蚕蚀性角膜溃疡复发的有效方法。
Objective To analyze the major risk factors of recurrent Mooren＇s ulcer after keratoplasty and explore the therapeutic Methods.Methods Thirty cases of Mooren＇s ulcer treated by keratoplasty were analyzed in Shandong Eye Hospital.The relationship between recurrence and monocular /binocular ulcer,systemic immune factors,medical administration postoperatively were analyzed and appropriate therapeutic strategies were designed according to the area and depths of recurrent ulcers.Results A total of 17 cases recurrent（56.7%,17 /30）.As with primary binocular ulcers,6 cases were included in recurrent group（35.3%,6 /17） and 2 in non-recurrent group（15.4%,2 /13）.As to immunologic indexes,7 cases were positive in recurrent group（41.2%,7 /17） and 6 in non-recurrent group（46.2%,6 /13）.In 17 recurrent cases,3 cases tried by medication didn＇t heal until treated by lamellar sclerokeratoplasty combined with amniotic membrane transplantation.Three cases with superficial ulcers treated by amniotic membrane transplantation,but one case recurred again related to irregular follow-up and was cured by conjunctival flaps.Eight cases with deep or large ulcers were treated by lamellar sclerokeratoplasty combined with amniotic membrane transplantation,but 2 cases recurred due to immunosuppressant administration irregularly,and the ulcers were cured by sclerolamellar keratoplasty again.Three severe cases with perforating ulcers were cured by perforative restoration by autogeneic lamellar corneal tissue and lamellar sclerokeratoplasty combined with amniotic membrane transplantation.Conclusion The risk factors in recurrent Mooren＇s ulcer after keratoplasty are related to binocular invasion,immune factors and whether or not regular administration ofimmunosuppressant postoperatively.Pure drug treatment can＇t cure the recurrent ulcer.Lamellar sclerokeratoplasty combined with amniotic membrane transplantation will be an effective therapeutic method.
出处
《临床眼科杂志》
2010年第4期289-292,共4页
Journal of Clinical Ophthalmology
关键词
蚕蚀性角膜溃疡
复发性
危险因素
板层角巩膜移植术
羊膜移植术
Mooren＇s ulcer
recurrence
Risk factor
Lamellar sclerokeratoplasty
Amniotic membrane transplantation
