中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
Chinese Journal of Practical Ophthalmology
2015年
7期
774-780
,共7页
罗平%胡艳珺%曾鹏%陈家祺%周世有
囉平%鬍豔珺%曾鵬%陳傢祺%週世有
라평%호염군%증붕%진가기%주세유
单纯疱疹病毒性角膜炎%羊膜遮盖%类固醇激素%抗病毒药物%角膜溃疡
單純皰疹病毒性角膜炎%羊膜遮蓋%類固醇激素%抗病毒藥物%角膜潰瘍
단순포진병독성각막염%양막차개%류고순격소%항병독약물%각막궤양
Herpes simplex keratitis%Amniotic membrane patching%Corticosteroids%Antivirus%Corneal ulceration
目的 探讨羊膜遮盖联合局部皮质类固醇激素滴眼液及全身抗病毒药物治疗难治性单纯疱疹病毒性角膜溃疡的疗效.方法 采用前瞻性病例研究.对2008年6月至2014年6月在中山大学中山眼科中心就诊的14只患有溃疡性基质型单纯疱疹病毒性角膜炎的患眼实施羊膜遮盖术.术后运用含0.1％皮质类固醇激素滴眼液点眼,同时口服更昔洛韦片抗病毒.观察分析患者手术前后角膜水肿、睫状充血及视力情况作为评价指标.结果 13只眼角膜溃疡在(11.31±4.19)d后完全愈合,前房积脓、角膜水肿和睫状充血也得到控制.末次随访时,有13只患眼视力提高l行及以上,手术后视力较术前显著提高(-0.86±0.53)logMAR差异有统计学意义(Z =-3.02,P＜0.01),1只眼视力无提高.治疗后炎症反应迅速减轻,角膜水肿及睫状充血情况在治疗前后差异有统计学意义(P＜0.05).水肿:术前评分(3.43±0.76)分,术后(0.57±1.50)分,差异有统计学意义(Z=-3.89,P＜0.001);睫状充血:术前评分(2.57±0.76)分,术后(0.50±0.85)分,差异有统计学意义(Z =-4.12,P＜0.01).6只眼溃疡处形成角膜云翳,4只眼溃疡处形成角膜斑翳,3只眼则形成角膜白斑,1只眼效果不佳最后失访.结论 羊膜遮盖联合局部类固醇激素滴眼液及全身抗病毒药物是治疗难治性单纯疱疹病毒性角膜溃疡一种行之有效的方法.
目的 探討羊膜遮蓋聯閤跼部皮質類固醇激素滴眼液及全身抗病毒藥物治療難治性單純皰疹病毒性角膜潰瘍的療效.方法 採用前瞻性病例研究.對2008年6月至2014年6月在中山大學中山眼科中心就診的14隻患有潰瘍性基質型單純皰疹病毒性角膜炎的患眼實施羊膜遮蓋術.術後運用含0.1％皮質類固醇激素滴眼液點眼,同時口服更昔洛韋片抗病毒.觀察分析患者手術前後角膜水腫、睫狀充血及視力情況作為評價指標.結果 13隻眼角膜潰瘍在(11.31±4.19)d後完全愈閤,前房積膿、角膜水腫和睫狀充血也得到控製.末次隨訪時,有13隻患眼視力提高l行及以上,手術後視力較術前顯著提高(-0.86±0.53)logMAR差異有統計學意義(Z =-3.02,P＜0.01),1隻眼視力無提高.治療後炎癥反應迅速減輕,角膜水腫及睫狀充血情況在治療前後差異有統計學意義(P＜0.05).水腫:術前評分(3.43±0.76)分,術後(0.57±1.50)分,差異有統計學意義(Z=-3.89,P＜0.001);睫狀充血:術前評分(2.57±0.76)分,術後(0.50±0.85)分,差異有統計學意義(Z =-4.12,P＜0.01).6隻眼潰瘍處形成角膜雲翳,4隻眼潰瘍處形成角膜斑翳,3隻眼則形成角膜白斑,1隻眼效果不佳最後失訪.結論 羊膜遮蓋聯閤跼部類固醇激素滴眼液及全身抗病毒藥物是治療難治性單純皰疹病毒性角膜潰瘍一種行之有效的方法.
목적 탐토양막차개연합국부피질류고순격소적안액급전신항병독약물치료난치성단순포진병독성각막궤양적료효.방법 채용전첨성병례연구.대2008년6월지2014년6월재중산대학중산안과중심취진적14지환유궤양성기질형단순포진병독성각막염적환안실시양막차개술.술후운용함0.1％피질류고순격소적안액점안,동시구복경석락위편항병독.관찰분석환자수술전후각막수종、첩상충혈급시력정황작위평개지표.결과 13지안각막궤양재(11.31±4.19)d후완전유합,전방적농、각막수종화첩상충혈야득도공제.말차수방시,유13지환안시력제고l행급이상,수술후시력교술전현저제고(-0.86±0.53)logMAR차이유통계학의의(Z =-3.02,P＜0.01),1지안시력무제고.치료후염증반응신속감경,각막수종급첩상충혈정황재치료전후차이유통계학의의(P＜0.05).수종:술전평분(3.43±0.76)분,술후(0.57±1.50)분,차이유통계학의의(Z=-3.89,P＜0.001);첩상충혈:술전평분(2.57±0.76)분,술후(0.50±0.85)분,차이유통계학의의(Z =-4.12,P＜0.01).6지안궤양처형성각막운예,4지안궤양처형성각막반예,3지안칙형성각막백반,1지안효과불가최후실방.결론 양막차개연합국부류고순격소적안액급전신항병독약물시치료난치성단순포진병독성각막궤양일충행지유효적방법.
Objective To investigate the effect of amniotic membrane patching (AMP) combined with topical steroids and systemic antivirus for refractory herpes simplex corneal ulcer.Methods This prospective interventional case series included 14 eyes of 14 consecutive patients with ulcerative stromal herpes simplex viral keratitis and/or endotheliitis which were irresponsive to therapeutic contact lens wearing as well as systemic and topical antiviral treatment for over 2 week.These patients were performed AMP.And then,topical 0.1％ dexamethasone eyedrops four times daily and ganciclovir tablets 0.5 gram three times daily were administered.The scores of the corneal edema,ciliary congestion and visian acuity before and after treatment were compared using the Rank sum test of ordinal categorical variables.Results The corneal ulcers were healed at day 11.31±4.19 in 13 of 14 patients after surgery.At the last visit,visual acuity was improved more than 1 line in 13 of 14 eyes.The difference between the pre-and post-operative visions was statistically significant (-0.86±0.53 logMAR,Z =-3.02,P ＜0.01).The inflammation was rapidly alleviated after treatment.The differences in the scores of the comeal edema and ciliary congestion before and after surgery were statistically significant (edema,3.43±0.76 vs.0.57±1.50,Z =-3.89,P ＜0.001;congestion,2.57±0.76 vs.0.50±0.85,Z =-4.12,P ＜0.001).At the last visit,corneal nebula was noted in 6 eyes,corneal macula in 4 eyes,corneal leukoma in 3 eyes;with unknown results in one eye lost to follow-up.Conclusions AMP combined with topical steroid eyedrops and systemic antiviral drugs could effectively promote corneal wound healing and alleviate the inflammation in HSK.This treatment is worthy to be recommended as a valuable approach for treating refractory ulcerative herpes simplex keratitis.
