Reidy J J, Paulus M P, Gona S
Department of Ophthalmology, The State University of New York, School of Medicine and Biomedical Sciences, Buffalo 14215, USA.
Cornea. 2000 Nov;19(6):767-71. doi: 10.1097/00003226-200011000-00001.
To evaluate the epidemiologic characteristics of a large clinical population of patients with recurrent erosions of the cornea. The efficacy of different modalities of treatment was also evaluated.
A retrospective chart review of all patients with the diagnosis of recurrent corneal erosion treated between January 1990 and December 1998 was performed.
Clinically confirmed recurrent erosions were identified in 104 patients. There were 36 males and 68 females. A history of trauma was present in 47 patients (45%), 30 patients (29%) had epithelial basement membrane dystrophy (EBMD), and 18 patients (17%) had both a history of trauma and evidence of EBMD. More than 87% of all erosions occurred on the inferior third of the cornea. Conservative therapy was used as the primary treatment in 52 patients with a recurrence rate of 6%. Corneal stromal micropuncture was performed on 38 patients with a recurrence rate of 40%. Eleven patients had epithelial debridement with a recurrence rate of 18%. Four patients had a superficial keratectomy with a diamond bur with a recurrence rate of 25%. Only one patient had an excimer phototherapeutic keratectomy, and she had a minor recurrence posttreatment.
In our series, the distribution of trauma and EBMD in patients with recurrent erosions of the cornea is roughly equivalent. Conservative therapy was effective in approximately one half of the patients. All surgical treatment modalities were associated with recurrences. Those patients with both EBMD and trauma were more likely to have a recurrence after treatment. More effective treatment modalities for recurrent erosions of the cornea need to be investigated.
评估大量复发性角膜糜烂患者的临床流行病学特征。同时评估不同治疗方式的疗效。
对1990年1月至1998年12月间所有诊断为复发性角膜糜烂的患者进行回顾性病历审查。
临床确诊复发性糜烂的患者有104例，其中男性36例，女性68例。47例患者（45%）有外伤史，30例患者（29%）有上皮基底膜营养不良（EBMD），18例患者（17%）既有外伤史又有EBMD证据。超过87%的糜烂发生在角膜下三分之一处。52例患者采用保守治疗作为主要治疗方法，复发率为6%。38例患者进行了角膜基质微穿刺，复发率为40%。11例患者进行了上皮清创术，复发率为18%。4例患者用钻石钻头进行了浅层角膜切除术，复发率为25%。只有1例患者进行了准分子光治疗性角膜切削术，术后有轻微复发。
在我们的系列研究中，角膜复发性糜烂患者的外伤和EBMD分布大致相当。保守治疗对大约一半的患者有效。所有手术治疗方式均有复发情况。同时患有EBMD和外伤的患者治疗后更易复发。需要研究更有效的角膜复发性糜烂治疗方式。
