多层新鲜羊膜移植对基质坏死型单纯疱疹病毒性角膜溃疡的疗效观察_临床医学论文.docVIP

多层新鲜羊膜移植对基质坏死型单纯疱疹病毒性角膜溃疡的疗效观察_临床医学论文 多层新鲜羊膜移植对基质坏死型单纯疱疹病毒性角膜溃疡的疗效观察_临床医学论文 【摘要】 　　目的：观察多层新鲜羊膜移植联合抗病毒药物和糖皮质激素治疗基质坏死型单纯疱疹病毒性角膜溃疡的临床疗效。方法：选择本院2002住院确诊此病的患者18例18眼，经局部及全身系统抗病毒治疗1wk以上，角膜溃疡迁延不愈，甚至有扩大、加深趋势，予行多层新鲜羊膜移植覆盖手术，术后联合抗病毒药物和糖皮质激素治疗。结果：术后18例患者角膜溃疡愈合，其中8例患者角膜恢复透明，10例患者角膜形成局限性斑翳或白斑。其中1例溃疡穿孔的患者，行羊膜移植术后，溃疡愈合，但形成瘢痕，视力低下，1a后予行角膜移植。结论：多层新鲜羊膜移植联合抗病毒药物和糖皮质激素是治疗基质坏死型单纯疱疹病毒性角膜溃疡的一种简单、经济、有效增视性治疗方法，可让患者恢复部分视力或保持角膜完整性，为角膜移植争取了机会。 【关键词】 羊膜；移植；基质坏死型角膜溃疡 　　Abstract　AIM：To evaluate the efficacy of multilayer amniotic membrane transplantation combined with antivirus and glucocorticosteroid drug to treat necrotizing herpes simplex stromal keratitis. METHODS: Eighteen patients (18 eyes) of necrotizing herpes simplex stromal keratitis were referred to the central hospital of Enshi Autonomous Prefecture between October 2002 and October 2009. Corneal inflammation persisted and corneal ulcer progressed despite topical and systemic antiviral treatment for over 1 week. Multilayer fresh amniotic transplantation was performed, and combined with antivirus and glucocorticosteroid drug after operation. RESULTS: Corneal ulcer healed after operation. Corneal transparence was achieved in 8 cases, partial corneal leucoma or macula in 10 cases. 1 of these patients, whose ulcer progressed to hole, adherent leucoma was formed, and corneal transplant was performed in 1 year. CONCLUSION：Multilayer fresh amniotic transplantation combined with antivirus and glucocorticosteroid treatment is an efficient method to treat necrotizing stromal keratitis. The method can recover some visual acuity, or keep the integrity of cornea for corneal transplantation.  　　KEYWORDS：amniotic membrane；transplantation；necrotizing herpes simplex stromal keratitis 　　0　引言 　　我院眼科自2002采用Holland等[1]（1999年）提出的单疱病毒性角膜炎（herps simplex stromal keratitis，HSK）新分类法指导临床诊治，进行系统性药物治疗，均取得良好的疗效，但其中基质坏死型单纯疱疹病毒性角膜溃疡，我科采用多层新鲜羊膜移植联合抗病毒药物和糖皮质激素治疗，取得满意疗效，现报告如下。 　　1　对象和方法 　　1.1　对象 　　观察2002在我院确诊的单疱病毒性角膜炎患者18例18眼，均根据Holland新分类法确诊基质坏死型HSK患者，其中男12例，女