蚕食性角膜溃疡治疗方式变迁及临床特征与疗效观察

摘要

Objective To investigate the clinical features,treatment distribution and transition of Mooren's ulcer,and to observe the clinical outcomes and recurrence.Methods Retrospective series case study.Medical records of 125 patients (154 eyes) with Mooren's ulcer treated between January 1996 and December 2015 at our hospital were retrospectively reviewed.Seventy-eight males and 47 females were include,with age of (47.6± 14.3) years (range:23-82 years) and median disease course of 6 months (range:1-240 months).Follow-up occurred between 4.5 and 122 months and the ratio of males to females was 1.66:1.All patients were divided into two groups:group 1996-2005 and group 2006-2015.Chi-square test was used to analyze the difference of treatment distribution between the two groups and recurrence rate relative to different risk factors.Clinical features and treatment outcomes of Mooren's ulcers were observed simultaneously.Results The lesion of the primary Mooren's ulcer involved nasal,temporal,superior,inferior and all limbus in 48,41,13,23 and 29 eyes,respectively.The numbers of eyes treated with medical therapy,LKP and amniotic membrane grafting were 6,61 and 1 in group 1996,with recurrence rate of 1/6,24.59％ and 0 respectively.The numbers in group 2006 were 27,38 and 14 with recurrence rate of 7.41％,34.21％ and 2/14,respectively.The differences of eyes underwent three different therapies were statistical significance between two groups (x2=29.315,P=0.000),but the differences of total recurrence rate were not (x2=0.149,P=0.699).Thirty-four patients (34 eyes) suffered ulcer recurrence,among which 23 eyes (67.65％) had recurrence within 12 months after treatment and 31 eyes (91.12％) were saved.Finally,150 of 154 eyes (97.40％) were saved and 129 eyes (83.77％) retained vision better than 0.05.Conclusions Mooren's ulcers were prone to occur in males and in patients older than 35 years.The lesion more often involved interpalpebral limbus.Lamellar keratoplasty was the most frequently used surgical intervention for primary Mooren's ulcer with a recurrence rate of 28.28％.In recent 10 years,the percentage of patients treated with LKP decreased while percentage of medical treatment and amniotic membrane grafting went up obviously,and the total recurrence rate between two groups had no statitical differences.%目的 探讨蚕食性角膜溃疡临床特征和治疗方式分布与变迁,观察临床疗效与复发情况.方法 回顾性系列病例研究.对1996年1月至2015年12月收住青岛眼科医院的蚕食性角膜溃疡患者125例(154只眼)进行研究,其中男性78例,女性47例.患者年龄为(47.6±14.3)岁,病程1～240个月(中位数6个月),随访4.5～122.0个月.将患者按就诊时间分为1996至2005年组和2006至2015年组,观察临床特征和治疗方法及其效果.采用卡方检验分析不同时期治疗方式的分布差异和不同影响因素下的复发情况.结果 角膜病灶累及鼻侧、颞侧、上方、下方和全周角膜缘的眼数分别为48、41、13、23和29只.1996至2005年组和2006至2015年组接受单纯药物治疗、板层角膜移植术(LKP)、羊膜移植术的眼数分别为6、61、1和27、38、14只;治疗后复发率分别为1/6、24.59％、0和7.41％、34.21％、2/14.3种治疗方式的眼数在两组之间的差异有统计学意义(x2=29.315,P=0.000),但两组治疗后总的复发率差异无统计学意义(x2=0.149,P=0.699).34例(34只眼)治疗后发生原发病复发,其中23只眼(67.65％)的复发发生于溃疡愈合后12个月内,91.18％(31只眼)经过治疗可以保住眼球.截至末次复诊,154只患眼中150只眼(97.40％)保住眼球,129只眼(83.77％)裸眼视力≥0.05.结论 蚕食性角膜溃疡好发于男性和年龄＞35岁的患者.病灶好发于睑裂区角膜缘.LKP是治疗蚕食性角膜溃疡的主要术式,术后复发率为28.28％.近10年行LKP的患者比例下降,单纯药物治疗和羊膜移植术所占比例明显升高,但各种治疗方式总的复发率较之前10年无明显差异.