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目的:评估角膜缘病变区球结膜环形切除联合羊膜移植治疗角膜缘病变为主的春季角结膜炎的临床效果。方法:对 10 例(20 眼)以角膜缘病变为特征的春季角结膜炎患者,采用角膜缘病变区球结膜环形切除联合羊膜移植的方法予以治疗。术后随访 5～21mo,观察其症状、体征的改变及复发情况。结果:手术后,患者症状明显改善:痒感、分泌物多、异物感等症状基本消失;手术后 1wk 内,畏光、流泪明显,后逐渐减轻,手术 1mo 后基本消失。角膜缘黄褐色或污红色胶样结节手术清除后在随访期间未复发;角膜上皮点状着色(11 眼),角膜溃疡(3 眼)于手术后 1wk 内愈合染色转阴且在随访期间未复发;术后球结膜充血逐渐减轻,19 眼手术1mo 后充血基本消失,且角膜缘羊膜移植区的球结膜较正常偏白,但有 1 眼术后球结膜充血间断反复约 5mo 并伴有轻度痒感,药物可减轻该眼的痒和充血,但多次出现反复。所有病例随访期间未发现严重的并发症。结论:角膜缘病变区球结膜切除联合羊膜移植治疗角膜缘病变为主的春季角结膜炎是有效安全的,但应严格选择手术对象。
Objective: To evaluate the clinical effect of corneal conjunctival resection combined with amniotic membrane transplantation for the treatment of limbal lesions of spring keratoconjunctivitis. Methods: Ten patients (20 eyes) with spring keratoconjunctivitis characterized by limbal lesion were treated by conjunctival resection combined with amniotic membrane transplantation. The patients were followed up for 5 ~ 21 months and their symptoms, signs and relapse were observed. Results: After the operation, the symptoms of the patients improved obviously: the symptoms such as itching, secretions and foreign body sensation disappeared basically; within 1wk after surgery, photophobia and tearing were obvious, and then gradually reduced. The operation disappeared after 1 month. Corneal limbus was brown or reddish gum-like nodules were not cleared of recurrence during follow-up; corneal epithelial punctate staining (11 eyes); corneal ulcer (3 eyes) healed within 1wk after surgery and turned negative during the follow-up period Recurrence; postoperative conjunctival hyperemia gradually reduced, 1 month after operation in 19 eyes the congestion disappeared basically, and the corneal limbal amniotic membrane graft conjunctiva than normal white, but there was 1 conjunctival hyperemia repeated intermittent about 5mo with light Degree of itching, the drug can reduce the itchy eyes and congestion, but repeated many times. No serious complications were found during follow-up in all cases. Conclusion: The conjunctival conjunctival resection combined with amniotic membrane transplantation for the treatment of limbal lesions in the spring keratoconjunctivitis is effective and safe, but should be strictly selected surgical objects.