Su Wan-Ya, Chang Shu-Wen, Huang Shiu-Feng
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.
Ophthalmic Surg Lasers Imaging. 2003 Mar-Apr;34(2):140-4.
Corneal perforation is one of the most vision-threatening consequences of vitamin A deficiency. Amniotic membrane transplantation was performed in a 36-year-old man who presented with bilateral corneal ulcers. There was a small, sharply demarcated superficial ulcer with crevices of surrounding keratinized epithelium converging on the ulcer and minimal infiltration at the inferior periphery of the right cornea. A 3-mm perforation on a 9 x 7-mm area of stromal melting was noticed in the left cornea. The serum vitamin A level was 14.0 microg/dL (normal, 24.57 to 105.71 microg/dL) at presentation. A biopsy of the right corneal epithelium was performed to confirm the diagnosis. Multilayered amniotic membrane transplantation with debridement of the necrotic corneal stroma was performed on the left cornea. In addition to systemic vitamin A replacement, topical antibiotics and lubricants were also administered. The cornea ulcers healed in 10 days along with the restoration of the serum vitamin A level. The visual acuity improved from 20/250 to 20/20 in the right eye and from light perception to hand movement in the left eye at 3 months. Amniotic membrane transplantation could save eyes with corneal perforation related to vitamin A deficiency before reconstructive surgeries, such as penetrating keratoplasty, are necessary.
角膜穿孔是维生素A缺乏最危及视力的后果之一。对一名患有双侧角膜溃疡的36岁男性进行了羊膜移植。右眼角膜下方周边有一个小的、边界清晰的浅表溃疡，周围角化上皮的裂隙向溃疡汇聚，浸润轻微。左眼角膜在9×7毫米的基质溶解区域有一个3毫米的穿孔。就诊时血清维生素A水平为14.0微克/分升（正常范围为24.57至105.71微克/分升）。对右眼角膜上皮进行活检以确诊。对左眼进行了多层羊膜移植并清除坏死的角膜基质。除了全身补充维生素A外，还给予了局部抗生素和润滑剂。角膜溃疡在10天内愈合，血清维生素A水平也恢复正常。3个月时，右眼视力从20/250提高到20/20，左眼视力从光感提高到手动。在进行穿透性角膜移植等重建手术之前，羊膜移植可以挽救因维生素A缺乏导致角膜穿孔的眼睛。
