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目的 :回顾性分析 2 0例棘阿米巴性角膜溃疡行角膜移植术的疗效 ,确定其手术适应证及手术疗效。方法 :2 0例患者中男性 12例 ,女性 8例 ,年龄 13～ 4 6岁。病因为戴角膜塑型镜 (OK镜 )者 10例 ,戴接触镜者 6例 ,角膜外伤者 4例。手术指征及手术方法 :临床药物治疗无效 ,且角膜病变区逐渐扩大并加深 ,有穿孔危险者。 2 0例患者中 17例采用板层角膜移植术 ,3例因病变较深而行穿透角膜移植术。术后患者仍局部滴用抗阿米巴药物 1～ 3个月。结果 :2 0例患者角膜病变均得到控制。 5例患者术后再次行穿透角膜移植术 ,术后裸眼视力为 0 3～ 0 6。 8例板层植片透明者视力为 0 0 5～ 0 4。未行穿透角膜移植术者 ,由于板层植片大量新生血管长入 ,需再次行板层角膜移植术联合角膜缘干细胞移植术。结论 :棘阿米巴性角膜溃疡药物治疗疗程长 ,难购药品 ,容易延误病情。对病变难以控制者 ,手术治疗为其有效的治疗方法。
Objective: To retrospectively analyze the curative effect of corneal transplantation for 20 patients with acanthamoeba keratomileusis and to determine the indications for its operation and the curative effect. Methods: There were 12 males and 8 females, 20 males and 13 to 46 years old. The cause of wearing corneal lens (OK mirror) in 10 cases, wearing contact lenses in 6 cases, 4 cases of corneal trauma. Surgical indications and surgical methods: clinical drug treatment is invalid, and the area of corneal lesions gradually expanded and deepened, there are perforation risk. Twenty-seven of the 20 patients underwent lamellar keratoplasty and 3 received penetrating keratoplasty due to the deeper lesions. Postoperative patients are still dropping drops of anti-amoebic drug 1 to 3 months. Results: Corneal lesions were controlled in 20 patients. Five patients underwent penetrating keratoplasty again after operation. The visual acuity after the operation was 0 3 ~ 0 6. Visual acuity was 0 0 5 ~ 0 4 in 8 cases with transparence of lamina. No penetrating corneal transplant who, due to a large number of implants neovascularization, need to re-line lamellar keratoplasty combined with limbal stem cell transplantation. Conclusions: Acanthamoeba keratitis drug treatment of long, difficult to purchase drugs, easy to delay the disease. Difficult to control the disease, surgical treatment for its effective treatment.