病灶切除联合羊膜移植治疗浅层角膜营养不良的临床观察

Local resection combined with amnion transplantation for superficial corneal dystrophy

目的研究病灶切除联合羊膜移植治疗浅层角膜营养不良的效果。设计回顾性病例系列。研究对象2009年1月-12月在北京同仁医院就诊的浅层角膜营养不良患者10例(12眼)。方法术前进行问卷调查了解眼部刺激症状,并进行评分。行视力、裂隙灯显微镜及角膜荧光素染色检查,并进行评分。行浅层病灶切除联合羊膜移植术,术后常规应用抗感染及角膜营养药物,刮除物行病理学检查。术后3个月再次行问卷调查、视力及角膜荧光素检查,观察评分变化。主要指标眼部症状,角膜荧光素染色评分,视力和组织病理学检查。结果患眼术前均有不同程度眼红、异物感、畏光、流泪等眼部刺激症状,术后3个月患者眼部刺激症状评分(4.38±1.06)较术前(12.50±1.31)有明显改善(P=0.002);术前角膜荧光素染色可见片状着染,评分为2.75±0.46,术后明显改善,评分为0.63±0.52(P=0.012)。视力由术前的平均0.06±0.03提高到术后的0.31±0.25(P=0.032)。组织病理学染色可见刮除物中粉染无定形物质沉积。结论病灶切除联合羊膜移植治疗浅层角膜营养不良可有效改善患者症状及视力。

Objective To study the effect of local resection combined with amnion transplantation in treating superficial corneal dystrophy. Design Retrospective case series. Participants Ten patients （12 eyes） of corneal dystrophy with superficial degeneration from Beijing Tongren Hospital during Jan to Dec 2009 were enrolled. Methods Questionnaire was used to record the irritating symptoms before surgery. The vision, slit lamp examination and corneal fluorescein staining examinations were also performed. Then local resections combined with amnion transplantation were performed. The specimens were sent for the pathologic examination after the operations. At three months after surgery, the questionnaire, vision, slit lamp and corneal fluorescein staining were followed up. Main Outcome Measures Ocular symptoms, vision, corneal fluorescein staining and histopathological examinations. Results The commom irritating symptoms were red eye, foreign body sensation, photophobia and tearing before surgery. The score of irritating symptoms （4.38±1.06）, corneal fluorescein staining （0.63±0.52） and the vision （0.31±0.25） were significantly improved at three months after surgery comparing with those before surgery （12.50±1.31, 2.75_＋0.46, and 0.06±0.25 respectively） （P=0.002, 0.012, and 0.032 respectively）. Pathologic results showed there were amorphous materials in the specimen. Conclusion Local resection combined with amnion transplantation in treating superficial corneal dystrophy is effective to improve the symptoms and the vision sight. （Ophthalmol CHN, 2011, 20： 165-168）