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目的研究病灶切除联合羊膜移植治疗浅层角膜营养不良的效果。设计回顾性病例系列。研究对象2009年1月-12月在北京同仁医院就诊的浅层角膜营养不良患者10例(12眼)。方法术前进行问卷调查了解眼部刺激症状,并进行评分。行视力、裂隙灯显微镜及角膜荧光素染色检查,并进行评分。行浅层病灶切除联合羊膜移植术,术后常规应用抗感染及角膜营养药物,刮除物行病理学检查。术后3个月再次行问卷调查、视力及角膜荧光素检查,观察评分变化。主要指标眼部症状,角膜荧光素染色评分,视力和组织病理学检查。结果患眼术前均有不同程度眼红、异物感、畏光、流泪等眼部刺激症状,术后3个月患者眼部刺激症状评分(4.38±1.06)较术前(12.50±1.31)有明显改善(P=0.002);术前角膜荧光素染色可见片状着染,评分为2.75±0.46,术后明显改善,评分为0.63±0.52(P=0.012)。视力由术前的平均0.06±0.03提高到术后的0.31±0.25(P=0.032)。组织病理学染色可见刮除物中粉染无定形物质沉积。结论病灶切除联合羊膜移植治疗浅层角膜营养不良可有效改善患者症状及视力。
Objective To study the effect of focal resection combined with amniotic membrane transplantation for the treatment of shallow corneal dystrophy. Design retrospective case series. Participants 10 cases (12 eyes) of patients with superficial corneal dystrophy who visited Beijing Tongren Hospital from January to December in 2009. Methods Preoperative questionnaire to understand the eye irritation symptoms, and score. Visual acuity, slit lamp microscopy and corneal fluorescein staining were performed and scored. Superficial lesion resection combined with amniotic membrane transplantation, postoperative routine anti-infective and corneal nutrition drugs, curettage and pathological examination. 3 months after the questionnaire survey again, visual acuity and corneal fluorescein examination, observation score changes. The main indicators of eye symptoms, corneal fluorescein staining score, visual acuity and histopathological examination. Results All eyes had ocular irritation with different degrees of redness, foreign body sensation, photophobia and tearing, and the eye irritation symptom score (4.38 ± 1.06) at 3 months after operation was significantly higher than that before the operation (12.50 ± 1.31) (P = 0.002). Preoperative corneal fluorescein staining showed flake staining with a score of 2.75 ± 0.46 and a significant improvement after operation. The score was 0.63 ± 0.52 (P = 0.012). Visual acuity increased from an average of 0.06 ± 0.03 preoperatively to 0.31 ± 0.25 postoperatively (P = 0.032). Histopathological staining shows the deposition of amorphous powder on the scrape. Conclusion The combination of focal resection and amniotic membrane transplantation for the treatment of superficial corneal dystrophy can effectively improve the symptoms and visual acuity of patients.