CAJ | 학술논문

目的分析探讨全身应用免疫抑制剂联合手术治疗合并坏死性巩膜炎的难治性蚕蚀性角膜溃疡的疗效.方法回顾性系列病例研究.山东省眼科医院2004年1月至2011年7月诊治的伴有坏死性巩膜炎的严重蚕蚀性角膜溃疡者7例(7眼).治疗原则:①药物治疗:口服环孢素胶囊和强的松片,根据病情减量维持半年,无复发时停用.局部应用1％环孢素滴眼液和妥布霉素地塞米松滴眼液,4次/d,逐渐减量维持.②手术治疗:巩膜坏死范围＜1/4象限者,行巩膜修补术；角膜溃疡范围≤全角膜1/2者,行部分板层角膜移植术;角膜溃疡范围＞全角膜1/2者或巩膜坏死范围＞1/2象限者均行结膜瓣遮盖术.术后3个月内每半个月复查1次,之后每个月复查1次至术后1年,1年后每2个月复查1次.结果 7例中有3例行结膜瓣遮盖术,4例行部分板层角膜移植术联合巩膜修补术.行结膜瓣遮盖术的3例患者术后结膜瓣血运好,溃疡愈合,眼表稳定,随访期间未见原发病复发.行部分板层角膜移植术联合巩膜修补术的4例,随访期间3例未见原发病复发,1例因自行停药1.5个月,巩膜自溶再次入院,给予巩膜修补术联合药物治疗,随访2年未见复发.随访期内7例患者未见角膜移植术后免疫排斥反应的发生,未见因药物副作用所致停药.结论全身应用免疫抑制剂联合手术治疗伴有坏死性巩膜炎的难治性蚕蚀性角膜溃疡有效,全身和局部联合应用免疫抑制剂可以明显提高手术成功率.
목적 분석탐토전신응용면역억제제연합수술치료합병배사성공막염적난치성잠식성각막궤양적료효.방법 회고성계렬병례연구.산동성안과의원2004년1월지2011년7월진치적반유배사성공막염적엄중잠식성각막궤양자7례(7안).치료원칙:①약물치료:구복배포소효낭화강적송편,근거병정감량유지반년,무복발시정용.국부응용1％배포소적안액화타포매소지새미송적안액,4차/d,축점감량유지.②수술치료:공막배사범위＜1/4상한자,행공막수보술；각막궤양범위≤전각막1/2자,행부분판층각막이식술;각막궤양범위＞전각막1/2자혹공막배사범위＞1/2상한자균행결막판차개술.술후3개월내매반개월복사1차,지후매개월복사1차지술후1년,1년후매2개월복사1차.결과 7례중유3례행결막판차개술,4례행부분판층각막이식술연합공막수보술.행결막판차개술적3례환자술후결막판혈운호,궤양유합,안표은정,수방기간미견원발병복발.행부분판층각막이식술연합공막수보술적4례,수방기간3례미견원발병복발,1례인자행정약1.5개월,공막자용재차입원,급여공막수보술연합약물치료,수방2년미견복발.수방기내7례환자미견각막이식술후면역배척반응적발생,미견인약물부작용소치정약.결론 전신응용면역억제제연합수술치료반유배사성공막염적난치성잠식성각막궤양유효,전신화국부연합응용면역억제제가이명현제고수술성공솔.
Objective To evaluate the efficacy of using immunosuppressive agents and surgery for refractory Mooren's ulcer combined with necroscleritis.Methods In a retrospective study,7 patients who were diagnosed with refractory Mooren's ulcer combined with necroscleritis between January 2004 and July 2011 at Shandong Eye Hospital were included.The treatment for the patients was determined by the following principles:first,oral cyclosporin A and prednisone were administered for half a year based on the condition,glucocoreicoid eye drops and cyclosporin A eye drops were used four times daily and reduced according to the condition; second,when the corneal ulcer area was smaller than half the area of the cornea,lamellar keratoplasty was performed; and when the area of the scleral necrosis was less than 1/4 quadrant,scleral neoplasty was performed; the remaining patients underwent conjunctival flap surgery.Patients were followed up twice a month for 3 months,once a month for 1 year and every two months thereafter.Results Three eyes were treated with conjunctival flap,and these 3 eyes recovered ocular surface stabilization.No recurrence was observed in these 3 patients during the follow-up period.The other 4 eyes were treated by lamellar keratoplasty combined with scleral neoplasty.In these patients,recurrence was discovered in 1 patient who had stopped using the systemic drugs.Scleral neoplasty was performed again on this patient,and postoperative medications were continued.No recurrence was observed.No significant complications related to drug use were observed in any patient during the study period.Conclusion The treatment of immunosuppresive agents and surgery are effective in patients with refractory Mooren's ulcer combined with necroscleritis.Using systemic and partial immunosuppresive agents can effectively decrease the incidence of recurrence.