改良羊膜移植联合角膜接触镜及免疫调节剂治疗复发性上皮型单纯疱疹病毒性角膜炎

Clinical study of modified amniotic membrane transplantation combined with corneal contact lens and immunemodulators in the treatment of recrudesced epithelial herpes simplex keratitis

目的观察改良新鲜羊膜移植联合软性角膜接触镜及免疫调节综合法治疗复发性上皮型单纯疱疹病毒性角膜炎的临床效果。方法选择2012年1月至2014年1月就诊于我院眼科的复发性上皮型单纯疱疹病毒性角膜炎患者56例,根据治疗方法不同分为治疗组和对照组,各28例。治疗组显微镜下彻底清除角膜病变组织后,将双层新鲜羊膜全角膜覆盖,巩膜浅层固定缝合一圈,之后给予软性角膜接触镜配戴;术后中药玉屏风颗粒治疗,更昔洛韦眼用凝胶涂术眼、口服盐酸伐昔洛韦片。对照组:仅给予更昔洛韦眼用凝胶及口服盐酸伐昔洛韦片治疗。术后随诊2 a。结果对照组治愈15例(53.6%),显效6例(21.4%),有效2例(7.1%),无效5例(17.9%),总有效率82.1%,6例复发(10.7%)。治疗组术后视力平均提高2.14行,而对照组仅为0.43行。治疗组术后治愈率、总有效率及视力提高水平均高于对照组,而复发率则低于对照组,差异均有统计学意义(均为P<0.05)。结论改良新鲜羊膜移植联合软性角膜接触镜及中药免疫调节治疗是一种全方位治疗,可快速有效控制炎症,促进溃疡修复,缩短病程,减轻临床症状的同时还可减少上皮型单纯疱疹病毒性角膜炎复发。

ObjectiveTo observe the clinical effects of fresh amniotic membrane transplantation combined soft corneal contact lens and immunomodulatory therapy on epithelial herpes simplex keratitis(HSK).MethodsTogether56participants with recrudesced epithelial type HSK were incorporated from January of2012to January of2014,and randomly divided into control group and treatment group according to random number table.The treatment group was performed complete removal of corneal lesions with microscope,and then the whole cornea was covered with double fresh amniotic membrane;after the whole limbus was fixed with continuous suturing,the soft contact lenses were worn at the end of the operation.After the operation,Chinese formula,including Yupingfeng particles,ganciclovir ophthalmic gel and oral valacyclovir hydrochloride tablets,was administrated.The control group was treated only with ganciclovir ophthalmic gel and oral valaciclovir hydrochloride tablets.ResultsIn control group,15patients(53.6%)were cured,6(21.4%)were markedly improved,2(7.1%)were effective,5(17.9%)was invalid,and the overall effective rate was82.1%,but6patients(21.4%)were recrudesced;while in the treatment group,22patients(78.6%)were cured,6(21.4%)were markedly improved,and the total effective rate was1000%,but3patients were recurred.Moreover,the visual acuity were improved about0.43visual lines in the control group,and about2.14lines in treatment group.Therefore,the curative rate,effective rate and visual improvement of the treatment group was significantly better than those of the control group(all P<0.05),but the recurrence rate was lower than that of the control group(P<0.05).ConclusionThe comprehensive treatment including fresh amniotic membrane transplantation combined corneal contact lens with Chinese formula were effective for quickly and effectively controlling inflammation,promoting ulcer repair and shortening the course of disease as well as reducing the recurrence.