Cameron J A
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Ophthalmology. 1995 Jun;102(6):985-93. doi: 10.1016/s0161-6420(95)30925-6.
Shield-shaped corneal ulcers and plaques are serious sight-threatening corneal manifestations of vernal keratoconjunctivitis. There are few reports describing the management of these patients and their outcomes.
The clinical presentation, treatment, and outcome of 66 shield ulcers and/or plaques in 55 eyes of 41 patients with vernal keratoconjunctivitis were studied in this retrospective study of patients treated at King Khaled Eye Specialist Hospital during an 11-year period.
Patients with shield ulcers where the base of the ulcer was transparent usually had rapid re-epithelialization and an excellent visual outcome with medical treatment alone. Patients with shield ulcers and visible plaque formation had delayed re-epithelialization when receiving only medical treatment. Complications of delayed re-epithelialization consisted of bacterial keratitis in five eyes, amblyopia in one eye, and strabismus in one patient.
Patients with shield ulcers and/or plaques that do not re-epithelialize once active vernal keratoconjunctivitis has been controlled should have surgical intervention. In this series, a simple scraping of the base and margins of the ulcer with removal of the inflammatory material (i.e., the plaque) resulted in rapid re-epithelialization in 20 of 23 ulcers and plaques. An algorithm for treating shield ulcers and/or plaques is presented based on the experience at this institution.
盾形角膜溃疡和角膜斑是春季角结膜炎严重的、威胁视力的角膜表现。关于这些患者的治疗及预后的报道较少。
本回顾性研究对在哈利德国王眼科专科医院接受治疗的41例春季角结膜炎患者的55只眼中的66个盾形溃疡和/或角膜斑的临床表现、治疗及预后进行了研究，研究为期11年。
溃疡底部透明的盾形溃疡患者通常仅通过药物治疗就能迅速实现上皮再形成且视力预后良好。仅接受药物治疗时，伴有可见角膜斑形成的盾形溃疡患者上皮再形成延迟。上皮再形成延迟的并发症包括5只眼发生细菌性角膜炎、1只眼发生弱视以及1例患者发生斜视。
一旦春季角结膜炎得到控制，盾形溃疡和/或角膜斑未实现上皮再形成的患者应接受手术干预。在本系列研究中，对23个溃疡和角膜斑中的20个进行溃疡底部及边缘的简单刮除并清除炎性物质（即角膜斑）后，实现了迅速上皮再形成。基于该机构的经验，给出了治疗盾形溃疡和/或角膜斑的算法。
