Jia Y N, Wang J T, Wang X, Yang Y, Gao H, Shi W Y
Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Eye Diseases, School of Ophthalmology, Shandong First Medical University, Jinan 250021, China.
Zhonghua Yan Ke Za Zhi. 2025 Feb 14;61(2):125-130. doi: 10.3760/cma.j.cn112142-20240710-00297.
To explore the clinical effectiveness of glucocorticoids combined with amniotic membrane transplantation in the treatment of severe marginal ulcerative keratitis. A retrospective case series study was conducted. Data from 10 patients (10 eyes) with marginal ulcerative keratitis who received glucocorticoid administration combined with amniotic membrane transplantation at the Eye Hospital of Shandong First Medical University from October 2017 to May 2022 were collected. There were 6 males and 4 females with an average age of 61.3 years. All patients underwent corneal scraping, bacterial culture, fungal culture, and confocal microscopy examination to exclude bacterial, fungal, and Acanthamoeba infections. The main indicators included visual acuity, intraocular pressure, corneal ulcer healing, and resolution of stromal edema. The follow-up after surgery ranged from 1 to 18 months. Postoperative visual acuity in all patients was significantly improved compared to preoperative levels. Among the 10 patients, 5 had partial abnormalities in blood immune indicators. For patients with purulent exudates attaching to the endothelial surface as shown on anterior segment optical coherence tomography, anterior chamber irrigation was performed to remove the exudates during surgery. Corneal ulcers healed within 1 to 2 weeks postoperatively, with negative corneal fluorescein stainings. Stromal edema completely resolved within 1 month. The superficial large amniotic membrane autolyzed or fell off within 7 to 10 days, while the inner amniotic membrane remained closely attached to the ulcer surface until the ulcer healed, shrinking as the ulcer surface decreased. Epithelial cells around the ulcer proliferated and gradually crawled to the surface of the small amniotic membrane on the ulcer surface, covering the corneal ulcer surface. The deep fibrous tissue of the ulcer and the amniotic membrane fused, filling the defect area of the ulcer tissue together. Patients with severe marginal ulcerative keratitis treated by glucocorticoid administration combined with amniotic membrane transplantation achieved favorable visual acuity improvement and corneal ulcer healing.
探讨糖皮质激素联合羊膜移植治疗重度边缘性溃疡性角膜炎的临床疗效。进行了一项回顾性病例系列研究。收集了2017年10月至2022年5月在山东第一医科大学附属眼科医院接受糖皮质激素联合羊膜移植治疗的10例（10眼）边缘性溃疡性角膜炎患者的数据。其中男性6例，女性4例，平均年龄61.3岁。所有患者均进行了角膜刮片、细菌培养、真菌培养和共焦显微镜检查，以排除细菌、真菌和棘阿米巴感染。主要指标包括视力、眼压、角膜溃疡愈合情况及基质水肿消退情况。术后随访1至18个月。所有患者术后视力均较术前显著提高。10例患者中，5例血液免疫指标有部分异常。对于眼前节光学相干断层扫描显示内皮表面有脓性渗出物附着的患者，术中进行前房冲洗以清除渗出物。角膜溃疡术后1至2周愈合，角膜荧光素染色阴性。基质水肿在1个月内完全消退。表层大片羊膜在7至10天内自溶或脱落，而内层羊膜在溃疡愈合前一直紧密附着于溃疡表面，随着溃疡面缩小而收缩。溃疡周围的上皮细胞增殖并逐渐爬行至溃疡表面小羊膜的表面，覆盖角膜溃疡面。溃疡的深层纤维组织与羊膜融合，共同填充溃疡组织的缺损区。糖皮质激素联合羊膜移植治疗重度边缘性溃疡性角膜炎患者视力改善良好，角膜溃疡愈合。
