角膜浅基质穿刺联合羊膜遮盖术在角膜病变中应用

The application of anterior corneal stromal puncture combined with amniotic membrane patching in corneal diseases

目的观察角膜浅基质穿刺联合羊膜遮盖术治疗大泡性角膜病变、持续性角膜上皮缺损、复发性角膜上皮糜烂等角膜病变的临床效果。方法回顾性病例系列研究。回顾分析2013年1月至2016年1月在唐山市眼科医院住院39例40只眼行角膜浅基质穿刺联合羊膜遮盖术患者。其中，大泡性角膜病变26例26只眼包括青光眼白内障术后7只眼，青光眼绝对期3只眼，玻璃体切除术后5只眼，眼外伤6只眼，新生血管性青光眼5只眼；持续性角膜上皮缺损8例8只眼包括碱烧伤4只眼，酸烧伤4只眼；复发性角膜上皮糜烂5例6只眼包括格子样营养不良1例2只眼，眼外伤4只眼。16例患者伴有糖尿病。以上患者均有明显疼痛、流泪刺激症状，患者经保守治疗无效。通过行角膜浅基质穿刺联合羊膜遮盖术治疗，术后观察眼部刺激症状，角膜上皮愈合、基质水肿及术后视力等情况。结果39例40只眼术后3d刺激症状缓解，术后7—10d拆除羊膜缝线，所有患者疼痛及刺激症状消失，裂隙灯检查角膜上皮修复完整。1个月后，1例1只眼大泡性角膜病变复发，再次行角膜浅基质穿刺后治愈。随访3-6个月，均未见角膜病变复发，角膜上皮光滑完整，基质无水肿，穿刺区角膜基质浅层形成一层均匀混浊斑。术后视力：22只眼手术前后视力无改变，18只眼视力部分提高。结论各种原因导致的大泡性角膜病变、持续性角膜上皮缺损、复发性角膜上皮糜烂患者，采用角膜浅基质穿刺联合羊膜遮盖术治疗，明显改善患者眼部症状，挽救了眼球，部分患眼改善了视力。我们认为角膜浅基质穿刺联合羊膜遮盖术是简便易行、效果可靠的治疗方法。

Objective To observe the clinical treatment of anterior corneal stromal puncture com- bined with amniotic membrane patching in bullous keratopathy and rsistent epithelial defects and re- current corneal erosion. Methods Retrospective case series study. Analysis retrospectively the treat- ment of bullous keratopathy in 39 cases, 40 eyes in Tangshan ophthalmic hospital from January 2013 to January 2016 which implement anterior corneal stromal puncture combined with amniotic membrane patching. Among them, in 26 cases with bullous keratopathy in 26 eyes including 7 eyes with cataract surgery for glaucoma, 3 eyes with absolute glaucoma period, 5 eyes with vitrectomy, 6 eyes with ocular trauma, 5 eyes with neovascular glaucoma. In 8 cases with rsistent epithelial de- fects in 8 eyes including 4 eyes with acid burn, 4 eyes with alkali bum. In 5 cases with recurrent corneal erosion in 6 eyes including 2 eyes with Lattice malnutrition, 4 eyes with ocular trauma, 16 cases with patients of diabetes. All patients had obvious pain, tears irritation symptom. When the treatment was invalid after conservative therapy. The anterior corneal stromal puncture combined with amniotic membrane patching was carried out, to observe the eye irritation, corneal epithelial healing, edema of matrix and postoperative visual acuity, and so on. Results Forty eyes in 39 cas- es were relieved 3 days after the surgery, all patients had no pain and irritation symptoms after am- niotic suture removal in 7-10 days. The corneal epithelium was repaired under the slit lamp micro- scope. One month the bullous keratopathy was recurrence after operation. In one eye which was cured with second anterior corneal stromal puncture. Follow up for 3-6 months, there were no recur- rence of keratopathy, corneal epithelium was smooth, no edema, corneal stromal puncture area shal- low layer to form a layer of uniform opacitas. The postoperative visual acuity： 22 eyes had no change before and after operation, 18 eyes improved partly. Conclusions The bullous keratopathy patients, resistant epithelial defects and recurrent corneal erosion caused by various factors are treat- ed with anterior corneal stromal puncture combined with amniotic membrane patching, the eye symp- tom is obviously improved. Not only save the eyeball, but also improve vision on some of the eye. The anterior corneal stromal puncture combined with amniotic membrane patching is a simple, effec- tive and reliable treatment method.