Sun Yi-Chen, Hsiao Cheng-Hsiang, Chen Wei-Li, Wang I-Jong, Hou Yu-Chih, Hu Fung-Rong
Department of Ophthalmology, Buddhist Tzu Chi General Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
Am J Ophthalmol. 2008 Mar;145(3):445-452. doi: 10.1016/j.ajo.2007.10.025. Epub 2008 Jan 16.
To evaluate the effectiveness of conjunctival resection combined with Tenon layer excision in treating superior limbic keratoconjunctivitis (SLK) and the involvement of mast cells in SLK.
Retrospective, interventional case series.
Forty eyes of 30 SLK patients who were unresponsive to medical treatment received superior bulbar conjunctival resection, and another 20 patients who underwent cataract and retinal surgery served as a control group. The conjunctiva specimens from study and control patients were examined by hematoxylin and eosin staining and immunohistochemistry using antibodies against mast cell tryptase.
In all operated eyes, the clinical symptoms and signs, including irritation and redness and superior bulbar conjunctival hyperemia and superior tarsal conjunctival papillary hypertrophy, subsided significantly three months after the operation. Only three eyes had recurrence from the margin of conjunctival resection, and this was relieved after reoperation. Keratinized conjunctival epithelium, loss of goblet cells, and increased mast cell numbers (P<.05) were found in the SLK group.
Our cases demonstrate that superior bulbar conjunctival resection combined with Tenon layer excision is an effective treatment for SLK. The pathologic findings suggest that mast cells may play a role in the pathogenesis of SLK.
评估结膜切除术联合眼球筋膜层切除术治疗上睑缘角结膜炎（SLK）的有效性以及肥大细胞在SLK中的作用。
回顾性、干预性病例系列研究。
对30例药物治疗无效的SLK患者的40只眼进行上睑结膜切除术，另外20例行白内障和视网膜手术的患者作为对照组。对研究组和对照组患者的结膜标本进行苏木精-伊红染色及使用抗肥大细胞类胰蛋白酶抗体的免疫组织化学检查。
所有手术眼术后3个月时，包括刺激感、眼红、上睑结膜充血及上睑结膜乳头肥大等临床症状和体征均明显减轻。仅3只眼在结膜切除边缘复发，再次手术后症状缓解。SLK组发现角化的结膜上皮、杯状细胞减少及肥大细胞数量增加（P<0.05）。
我们的病例表明，上睑结膜切除术联合眼球筋膜层切除术是治疗SLK的有效方法。病理结果提示肥大细胞可能在SLK的发病机制中起作用。
