Dostálek M, Krásný J, Spicka I, Sach J
Ortoptická cást, Ocní oddelení, Nemocnice, Litomysl.
Cesk Slov Oftalmol. 2005 Jan;61(1):38-49.
Authors refer about detailed analysis of ten years follow up of a child patient with ligneous conjunctivitis. They document presence of all typical eye findings (especially recurrent formation of granulomatous pseudotumors in affected mucous membrane) related to this rare pseudomembranous conjunctivitis. The clinical picture of the disease includes plasminogen deficiency, a factor newly considered as primary cause of the disease. The diagnosis was confirmed histologicaly by repeated probatory excisions. Pseudomembranous inflammation with mixed inflammatory infiltrate containing large amount of elements of chronical as well as acute inflammatory reaction is typical. Granuloma with the accumulation of the PAS-positive amorphous matrix with high content of the fibrin and with the network of newly formed vessels is the component of the inflammatory picture. The treatment was based on successively discovered knowledge of the possible etiopathogenesis of the disease. Only the ninth, last surgical procedure induced longer-term remission, which lasts sixteen months until now. The granuloma excision was combined with the mitomicin application on the wound surface and a conjunctivoplasty. During the postoperative period, the ointment with heparin, corticosteroid and antibiotic was applied. The purpose of the mitomicin use is to slow down the fibroproliferative reparative reaction. Covering of the wound surface decreases the number of microtraumas on the uneven postoperative scleral surface. Heparin in the interstitial tissue of the wound surface blocks the conversion of fibrinogen to fibrin.
作者介绍了一名患有木质性结膜炎儿童患者的十年随访详细分析。他们记录了与这种罕见的假膜性结膜炎相关的所有典型眼部表现（尤其是在受影响黏膜中反复形成肉芽肿性假肿瘤）。该疾病的临床表现包括纤溶酶原缺乏，这是一个新被认为是该疾病主要病因的因素。通过反复的探查性切除，组织学确诊了该疾病。典型表现为假膜性炎症，伴有混合性炎症浸润，包含大量慢性和急性炎症反应成分。肉芽肿伴有PAS阳性无定形基质的积聚，其中纤维蛋白含量高，并伴有新形成的血管网络，是炎症表现的组成部分。治疗基于对该疾病可能的病因发病机制的逐步发现的认识。只有第九次也是最后一次手术诱导了长期缓解，至今已持续16个月。肉芽肿切除与丝裂霉素应用于创面及结膜成形术相结合。术后期间，应用含有肝素、皮质类固醇和抗生素的眼膏。使用丝裂霉素的目的是减缓纤维增生性修复反应。覆盖创面可减少术后巩膜表面不平整处的微创伤数量。创面间质组织中的肝素可阻止纤维蛋白原转化为纤维蛋白。
