部分永久性睑缘缝合联合自体血清治疗重度神经营养性角膜病变疗效观察

Topical autologous serum administration and partial permanent tarsorrhaphy to treat severe neurotrophic keratopathy

目的评价部分永久性睑缘缝合联合自体血清治疗重度神经营养性角膜病变的疗效。方法回顾性临床对照研究,对2014年7月至2015年6月在武汉大学人民医院眼科诊断为神经营养性角膜病变患者,选出22例单纯药物治疗无效的重度患眼,随机分配两组,每组11例进行治疗,A组采用部分永久性睑缘缝合术,B组采用羊膜移植术,术后均自体血清滴眼,4次/天。观察治疗有效率,角膜基质厚度变化,上皮愈合时间及角膜神经恢复情况。结果 A组治疗有效率更高(A组90.91%,B组54.55%,P<0.05),A组治疗无效者发生角膜后弹力层脱离,B组无效患者中4例出现角膜上皮愈合障碍,1例角膜穿孔。共焦显微镜观察治疗有效者神经密度增加。随访时间[A组(22.82±8.998)周;B组(27.91±9.523)周,P>0.05]、术前症状评分(A组3.000±0.775;B组2.455±0.934,P>0.05)、角膜基质厚度改变[A组(113.40±153.6)mm;B组(94.27±105.)mm,P>0.05]以及上皮愈合时间[A组(31.80±9.077)d;B组(28.50±4.970)d,P>0.05]的差别均无统计学意义。结论相比于羊膜移植联合自体血清,部分永久性睑缘缝合联合自体血清更有利于治疗重度的神经营养型角膜病变。

Objective To evaluate the effects of topical autologous serum eye drops and partial permanent tarsorrhaphy on severe neurotrophic keratopathy. Methods This is a retrospective case-control report. A total of 22 patients diagnosed with severe neurotrophic keratopathy（ NK） in People＇s Hospital of Wuhan University between July 2014 and June2015. All patients had been unsuccessfully treated with conventional medication therapy. Patients were randomly assigned to two groups. Group A patients were treated with topical autologous serum administration 4 times a day combined with partial permanent tarsorrhaphy,and group B patients were treated with autologous serum 4 times a day and amniotic membrane transplantation. Effective rate,changes in corneal stroma thickness,epithelial healing time and corneal nerve recovery were observed. Results Effective rate in group A is 90. 91%,significantly higher than in group B（ 54. 55%; P〈0. 05）. The causes of unsuccessful cases were Descemet＇s membrane detachment in group A,and corneal epithelial healing disorders（ n = 4） and corneal perforation（ n = 1） in group B. Corneal sensitivity significantly increased as measured by in vivo confocal microscope. Follow-up time were similar between the two groups（ 22. 82 ± 8. 998 vs. 27. 91 ± 9. 523 weeks; P〈0. 05）,preoperative symptoms score（ 3. 000 ± 0. 775 vs. 2. 455 ± 0. 934; P〈0. 05）,stromal thickness（ 113. 40 ± 153. 6vs. 94. 27 ± 105. 8 mm; P〈0. 05） and epithelial healing time（ 31. 80 ± 9. 077 vs. 28. 50 ± 4. 970 days; P〈0. 05）.Conclusion Autologous serum administration plus partial permanent tarsorrhaphy is more effective than amniotic membrane transplantation to treat severe types of neurotrophic keratopathy.