摘要目的 观察羊膜移植术治疗难治性角膜溃疡的临床疗效.方法 回顾分析2013年1月至2015年12月在唐山市眼科医院实施羊膜移植术治疗的难治性角膜溃疡37例37只眼.其中,细菌性角膜溃疡3只眼,病毒性角膜溃疡10只眼,免疫性角膜溃疡7只眼,神经麻痹性角膜溃疡4只眼,粥样角膜溃疡7只眼,热烫伤3只眼,碱烧伤3只眼.溃疡迁延不愈,所有患者均进行角膜病灶切除联合羊膜移植术,术后继续针对原发病进一步药物治疗.术后定期复查视力和眼压,裂隙灯显微镜观察角膜溃疡愈合情况,羊膜眼表愈合、角膜基质水肿、角膜新生血管的变化情况,荧光素钠染色观察角膜上皮的愈合情况.结果 37例37只眼中有36只眼1次手术治愈.3例3只眼合并角膜溃疡穿孔者中2只眼(1只眼基质坏死型单纯疱疹病毒性角膜溃疡和1只眼免疫性角膜溃疡)实施了双层羊膜移植术后1次治愈,1只眼(基质坏死型单纯疱疹病毒性角膜溃疡)行羊膜移植术,又行穿透性角膜移植术后治愈.随访3～6个月,36例36只眼角膜溃疡愈合,羊膜完全吸收,角膜形成瘢痕性混浊.术后视力:37只眼维持原视力或部分提高.其中手动/眼前～指数/眼前有18只眼,指数～0.1有9只眼,＞0.12有10只眼.结论 对于药物治疗无效的难治性角膜溃疡,羊膜移植术是行之有效的方法之一,为增视性角膜移植手术提供良好机会.

abstractsObjective To study the clinical curative effect of amniotic membrane transplantation surgery in treatment of refractory corneal ulcer.Methods Thirty-seven patients (37 eyes) with refractory comeal ulcer that underwent amniotic membrane transplantation surgery were retrospectively analyzed,including 3 cases with bacterial corneal ulcer,10 cases with viral comeal ulcer,7 cases with immunity corneal ulcer,4 cases with neuroparalytic comeal ulcer,7 cases with atheromatous comeal ulcer,3 cases with thermal bums,3 cases with alkali bums.All the patients were treated with removal of the necrotic corneal tissue combining amniotic membrane transplantation surgery when the comeal ulcer were protracted course of disease.And the medical therapy was further used to treat the primary disease after the operation.The follow-up time was from 3 months to 6 months,and the visual acuity and intraocular pressure were reviewed regularly.Comeal ulcer healing,amniotic membrane ocular surface healing,the change of corneal stromal edema,comeal neovascularization with the slit lamp microscope,and the healing of corneal epithelium with sodium fluorescein staining were observed.Results Thirty-six eyes were cured with one surgery in 37 eyes of the 37 cases;3 eyes with comeal ulcer perforation were cured,and 2 eyes were carried out double amniotic membrane transplantation including 1 case with matrix necrosis type simple viral corneal ulcer and 1 case with immunity comeal ulcer,and 1 case with matrix necrosis type simple viral corneal ulcer was cured by amniotic membrane transplantation and penetrating keratoplasty.The follow-up time was from 3 months to 6 months,corneal ulcer in 36 cases (36 eyes) were healing,the amniotic membrane was completely absorbed,the corneal mcul were formed.Postoperative visual acuity:37eyes maintained the original vision or were increased partly,including 18 cases were from hand move to count fimger,9 cases were from count finger to 0.1,and 10 cases were more than 0.12.Conclusions For those intractable corneal ulcer which is invalid by drug treatment,amniotic membrane transplantation is one of the effective methods to provide good opportunities for increased visibility corneal transplant.