Shi Wei-yun, Chen Min, Wang Fu-hua, Zhao Jing, Ma Lin, Xie Li-xin
Shandong Eye Institute & Qingdao Eye Hospital, Qingdao 266071, China.
Zhonghua Yan Ke Za Zhi. 2005 Dec;41(12):1107-11.
To evaluate the efficacy of multilayer amniotic membrane transplantation (AMT) combined with antivirus and corticosteroid drug to treat necrotizing herpes simplex stromal keratitis.
Thirteen patients (13 eyes) of necrotizing stromal keratitis were referred to Shandong Eye Institute and Qingdao Eye Hospital between January 2003 and April 2004. The course of disease was 3 - 22 months (mean 15 months). Corneal inflammation persisted and corneal ulcer progressed despite topical and systemic antiviral treatment for over 1 weeks. Multilayer amniotic membrane transplantation was performed after excluding of bacterial and fungal infection by microbiologic studies including smears and cultures of necrotic corneal tissue and confocal microscope. Topical and systemic antiviral medications were given with adjuvant corticosteroid eyedrops postoperatively. We investigated the healing of corneal ulcer and improvement of stromal edema with slit lamp biomicroscope, the integrity of corneal defect with fluorescein staining, the migration of healthy corneal epithelial cells and transformation of amniotic membrane with confocal microscopy. All patients were followed up for 3 - 13 months (mean 10 months).
Corneal ulcer healed within 1 - 3 weeks postoperatively with negative fluorescein staining. Corneal stromal edema faded away within 1 month. Superficial amniotic membrane patches dissolved or shed on postoperative day 7 - 10, while the deeper grafts were adhered into the ulcer and fused with the surrounding fibroblasts. One of these grafts remained in situ more than 3 months. Confocal microscope examination indicated flat epithelial progenitor cells on the surface of residual amniotic membrane. Corneal transparence was achieved in 7 eyes, macula in 4 eyes and leucoma in 2 eyes 3 months after the operation. No recurrence of necrotizing stromal keratitis was occurred in 13 patients during the follow-up period.
Multilayer AMT combined with antivirus and corticosteroid treatment is an effective method to treat necrotizing herpes simplex stromal keratitis.
评估多层羊膜移植（AMT）联合抗病毒及糖皮质激素药物治疗坏死性单纯疱疹性基质性角膜炎的疗效。
2003年1月至2004年4月期间，13例（13眼）坏死性基质性角膜炎患者被转诊至山东眼科研究所和青岛眼科医院。病程为3 - 22个月（平均15个月）。尽管局部和全身应用抗病毒治疗超过1周，角膜炎症仍持续，角膜溃疡仍进展。通过包括坏死角膜组织涂片和培养以及共聚焦显微镜检查在内的微生物学研究排除细菌和真菌感染后，进行多层羊膜移植。术后给予局部和全身抗病毒药物，并辅助使用糖皮质激素滴眼液。我们用裂隙灯生物显微镜观察角膜溃疡的愈合情况和基质水肿的改善情况，用荧光素染色观察角膜缺损的完整性，用共聚焦显微镜观察健康角膜上皮细胞的迁移和羊膜的转化。所有患者随访3 - 13个月（平均10个月）。
术后1 - 3周角膜溃疡愈合，荧光素染色阴性。角膜基质水肿在1个月内消退。浅表羊膜片在术后第7 - 10天溶解或脱落，而较深的移植片粘附于溃疡处并与周围成纤维细胞融合。其中一片移植片原位留存超过3个月。共聚焦显微镜检查显示残留羊膜表面有扁平的上皮祖细胞。术后3个月，7眼角膜恢复透明，4眼有斑翳，2眼有白斑。13例患者在随访期间均未发生坏死性基质性角膜炎复发。
多层羊膜移植联合抗病毒及糖皮质激素治疗是治疗坏死性单纯疱疹性基质性角膜炎的有效方法。
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