羊膜遮盖联合激素及抗病毒治疗单疱病毒性角膜溃疡疗效观察

Amniotic membrane patching combined with steroids and antivirus for refractory herpes simplex corneal ulcer

目的 探讨羊膜遮盖联合局部皮质类固醇激素滴眼液及全身抗病毒药物治疗难治性单纯疱疹病毒性角膜溃疡的疗效.方法 采用前瞻性病例研究.对2008年6月至2014年6月在中山大学中山眼科中心就诊的14只患有溃疡性基质型单纯疱疹病毒性角膜炎的患眼实施羊膜遮盖术.术后运用含0.1％皮质类固醇激素滴眼液点眼,同时口服更昔洛韦片抗病毒.观察分析患者手术前后角膜水肿、睫状充血及视力情况作为评价指标.结果 13只眼角膜溃疡在（11.31±4.19）d后完全愈合,前房积脓、角膜水肿和睫状充血也得到控制.末次随访时,有13只患眼视力提高l行及以上,手术后视力较术前显著提高（-0.86±0.53）logMAR差异有统计学意义（Z =-3.02,P＜0.01）,1只眼视力无提高.治疗后炎症反应迅速减轻,角膜水肿及睫状充血情况在治疗前后差异有统计学意义（P＜0.05）.水肿：术前评分（3.43±0.76）分,术后（0.57±1.50）分,差异有统计学意义（Z=-3.89,P＜0.001）;睫状充血：术前评分（2.57±0.76）分,术后（0.50±0.85）分,差异有统计学意义（Z =-4.12,P＜0.01）.6只眼溃疡处形成角膜云翳,4只眼溃疡处形成角膜斑翳,3只眼则形成角膜白斑,1只眼效果不佳最后失访.结论 羊膜遮盖联合局部类固醇激素滴眼液及全身抗病毒药物是治疗难治性单纯疱疹病毒性角膜溃疡一种行之有效的方法。

Objective To investigate the effect of amniotic membrane patching （AMP） combined with topical steroids and systemic antivirus for refractory herpes simplex corneal ulcer.Methods This prospective interventional case series included 14 eyes of 14 consecutive patients with ulcerative stromal herpes simplex viral keratitis and/or endotheliitis which were irresponsive to therapeutic contact lens wearing as well as systemic and topical antiviral treatment for over 2 week.These patients were performed AMP.And then,topical 0.1% dexamethasone eyedrops four times daily and ganciclovir tablets 0.5 gram three times daily were administered.The scores of the corneal edema,ciliary congestion and visian acuity before and after treatment were compared using the Rank sum test of ordinal categorical variables.Results The corneal ulcers were healed at day 11.31±4.19 in 13 of 14 patients after surgery.At the last visit,visual acuity was improved more than 1 line in 13 of 14 eyes.The difference between the pre-and post-operative visions was statistically significant （-0.86±0.53 logMAR,Z =-3.02,P 〈0.01）.The inflammation was rapidly alleviated after treatment.The differences in the scores of the comeal edema and ciliary congestion before and after surgery were statistically significant （edema,3.43±0.76 vs.0.57±1.50,Z =-3.89,P 〈0.001;congestion,2.57±0.76 vs.0.50±0.85,Z =-4.12,P 〈0.001）.At the last visit,corneal nebula was noted in 6 eyes,corneal macula in 4 eyes,corneal leukoma in 3 eyes;with unknown results in one eye lost to follow-up.Conclusions AMP combined with topical steroid eyedrops and systemic antiviral drugs could effectively promote corneal wound healing and alleviate the inflammation in HSK.This treatment is worthy to be recommended as a valuable approach for treating refractory ulcerative herpes simplex keratitis.