改良羊膜移植联合角膜接触镜及免疫调节剂治疗复发性上皮型单纯疱疹病毒性角膜炎

发布时间：2018-11-13 12:57

【摘要】：目的观察改良新鲜羊膜移植联合软性角膜接触镜及免疫调节综合法治疗复发性上皮型单纯疱疹病毒性角膜炎的临床效果。方法选择2012年1月至2014年1月就诊于我院眼科的复发性上皮型单纯疱疹病毒性角膜炎患者56例,根据治疗方法不同分为治疗组和对照组,各28例。治疗组显微镜下彻底清除角膜病变组织后,将双层新鲜羊膜全角膜覆盖,巩膜浅层固定缝合一圈,之后给予软性角膜接触镜配戴;术后中药玉屏风颗粒治疗,更昔洛韦眼用凝胶涂术眼、口服盐酸伐昔洛韦片。对照组:仅给予更昔洛韦眼用凝胶及口服盐酸伐昔洛韦片治疗。术后随诊2 a。结果对照组治愈15例(53.6%),显效6例(21.4%),有效2例(7.1%),无效5例(17.9%),总有效率82.1%,6例复发(10.7%)。治疗组术后视力平均提高2.14行,而对照组仅为0.43行。治疗组术后治愈率、总有效率及视力提高水平均高于对照组,而复发率则低于对照组,差异均有统计学意义(均为P0.05)。结论改良新鲜羊膜移植联合软性角膜接触镜及中药免疫调节治疗是一种全方位治疗,可快速有效控制炎症,促进溃疡修复,缩短病程,减轻临床症状的同时还可减少上皮型单纯疱疹病毒性角膜炎复发。
[Abstract]:Objective to observe the clinical effect of modified fresh amniotic membrane transplantation combined with soft corneal contact lens and immunomodulation in the treatment of recurrent epithelial herpes simplex virus keratitis. Methods from January 2012 to January 2014, 56 patients with recurrent epithelial herpes simplex keratitis were selected and divided into treatment group (n = 28) and control group (n = 28). In the treatment group, the fresh amniotic membrane was covered with a double layer of fresh amniotic membrane and the superficial sclera was fixed and sutured for one lap, and the soft contact lens was used after thoroughly removing the pathological changes of the cornea under the microscope in the treatment group. After operation, Chinese medicine Yupingfeng granule, ganciclovir eyes with gel coating, oral valaciclovir hydrochloride tablets. Control group: only ganciclovir eye gel and oral valciclovir hydrochloride treatment. Postoperative follow-up was 2 years. Results in the control group, 15 cases (53.6%) were cured, 6 cases (21.4%) were effective, 2 cases (7.1%) were effective, 5 cases (17.9%) were ineffective, and the total effective rate was 82.1% (10.7%). The visual acuity was improved by 2.14 lines in the treatment group and 0.43 in the control group. The cure rate, total effective rate and visual acuity in the treatment group were higher than those in the control group, while the recurrence rate was lower than that in the control group (P0.05). Conclusion modified fresh amniotic membrane transplantation combined with soft cornea contact lens and traditional Chinese medicine immunomodulation therapy is a kind of omnidirectional treatment, which can quickly and effectively control inflammation, promote ulcer repair and shorten the course of disease. Reducing clinical symptoms can also reduce the recurrence of epithelial herpes simplex keratitis.
【作者单位】：广州医科大学附属第一医院眼科;中山大学中山眼科中心;
【基金】：广东省科技计划项目(编号:2013B022000086) 广东省公益研究与能力建设专项资金(编号:2014A020212365) 广东省科技计划项目(编号:2011B031800112)~~
【分类号】：R779.6

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