角膜层间灼烙联合羊膜嵌入移植术治疗大泡性角膜病变

Corneal intralamellar thermo cauterization combined with patch amniotic membrane transplantation in management of bullous keratopathy

目的评价白体角膜板层分离联合层间灼烙及羊膜嵌入移植术治疗大泡性角膜病变的临床效果。方法对2000～2012年在河南省眼科研究所就诊的12例（12只眼）施行自体角膜板层分离联合层间灼烙及羊膜嵌入移植术，男8例，女4例，年龄51—72岁，平均61岁。外伤性白内障术后发病4例，年龄相关性白内障超声乳化术后发病5例，青光眼联合白内障术后3例。观察患者疼痛症状、羊膜移植片吸收及角膜完全上皮化时间、治疗前后视力改善以及角膜大泡复发和术后并发症等。随诊观察6～24个月，平均20个月。结果全部病人术后眼部刺激症状立即缓解，上皮水泡消失，术后一个月角膜基质水肿消退，角膜上皮修复完整，层间羊膜移植片呈膜状轻度混浊。随访6～24个月均未发现眼部刺激症状及角膜大泡复发，大部分患者保存原有残留视力。结论自体角膜板层分离联合层间灼烙及羊膜嵌入移植术是治疗大泡性角膜病变的有效方法。

Objective To assess the efficacy of autologous lamellar corneal separation combined with corneal intralamellar thermo cauterization （CITC） and patch amniotic membrane transplantation （PAMT） for symptomatic relief in painful bullous keratopathy （PBK）. Methods Twelve eyes of 12 patients with symptomatic bullous keratopathy and poor visual potential were selected, male 8 cases, female 4 cases; age from 51 to 72 years old, average age 61 years, 4 cases traumatic cataract sur- gery combined with intraocular lens implantation, 5 cases phacoemulsification cataract surgery, 3 cas-es cataract surgery combined with anti-glaucoma surgery. The patients were treated with autologous lamellar corneal separation combined with CITC and PAMT. All patients were followed up for at least 6 months. Outcome parameters included symptomatic relief, time taken for surface re-epitheliali- zation and graft dissolution, change in corneal thickness, visual acuity improvement and complica- tions. Results At follow-up, a significant decrease was seen in the symptom scores after surgery in all patients. Corneal bullae disappeared after surgery. Complete epithelialization was noted 4 weeks postoperatively in 12 eyes. Amniotie membrane dissolved or fell off after 4 weeks. And visual acu-ity had no improvement compared with pre-operation. No case had recurrence. Conclusions Autolo-gous lamellar corneal separation combined with CITC and PAMT is effective to provide symptomat-ic relief in patients with PBK and poor visual potential.