角膜移植联合
FK506 治疗单疱病毒性角膜炎
【摘要】目的:探讨角膜移植联合
FK506 治疗严重单疱病毒性角膜炎的
临床疗效。方法:对临床确诊为单疱病毒性角膜炎且经抗病毒药物治疗无效的患
者行角膜移植术。根据单纯疱疹病毒性角膜炎累及角膜范围及深度的不同程度分
别行板层角膜移植术和穿透性角膜移植术共
15 例 15 眼。治疗性角膜移植术后给
予抗炎防感染治疗并应用
FK506 滴眼液局部点眼,术后随访 6~24mo。观察术
后患者视力、植片的透明度及并发症等情况。结果:治疗性角膜移植术后
15 例患
者中,
14 例患者术眼视力均有不同程度的恢复(0.05~0.6),其中 12 例植片透明,
2 例植片轻度混浊;1 例术后出现明显的排斥反应而失败。其中继发性青光眼 7%
(1 眼),并发性白内障的 7% (1 眼)。结论:角膜移植联合 FK506 治疗单疱病毒性
角膜炎相对安全有效的方法。
【关键词】
单疱病毒性角膜炎;角膜移植;FK506
Corneal transplantation combined with FK506 for herpes simplex keratitis
Wei Peng, JuTian Huang, XiaoLing Luo, Qiong Xiao
Department of Ophthalmology, Shenzhen Peoples Hospital, Shenzhen
518020,Guangdong Province,China
Abstract AIM: To observe the therapeutic effects of corneal transplantation
combined with FK506 for herpes simplex keratitis(HSK).METHODS: Lamellar
keratoplasty and penetrating keratqdasty were applied according to the different range
and depth of cornea affected by HSK in 15 cases 15 eyes diagnosed with HSK, for
whom antivirus drugs had no effect. Clinical effects and complications of corneal
transplantation combined with FK506 for HSK were studied postoperatively, and
cases were followed up for 624 months.RESULTS:Visual acuity of 14 cases
improved in various degrees, ranging from 0.05 to 0.6. 12 cases were of transparent
grafts, 2 cases of mild turbidity grafts;1 case of apparent rejection and failure.
Secondary glaucoma was in 7% (1 case)and complicated cataract 7% (1
case).CONCLUSION: Its effective and safe that corneal transplantation combined
with FK506 for treatment of HSK.
KEYWORDS: herpes simplex keratitis;corneal transp
lantation;FK506
0 引言
单疱病毒性角膜炎
(herpes simplex keratitis, HSK)是当今世界上危害严重的
感染性眼病之一,发病率占角膜病的首位,由于抗生素和皮质类固醇的广泛应
用,其发病率有上升趋势。往往因反复发作而严重影响危害视功能,临床尚无有
效控制复发的药物,因而成为一种世界性的重要致盲原因
[1]。对于严重损伤角
膜甚至威胁到眼球的病例,常常需要进行角膜移植术,而术后疗效因为植片免
疫排斥反应和单疱病毒性角膜炎复发而失败,本临床研究中采用板层或穿透性
角膜移植治疗严重或者复发性单疱病毒性角膜炎
,术后抗病毒及感染的同时联合
他克莫司
(tncrotimus,FK506)滴眼液进行抗免疫排斥治疗,取得较好临床效果。
1 对象和方法
1.1 对象
我科在
200701/200901 对严重单疱病毒性角膜炎引起角膜中央深层混
浊导致视力下降,累积全层或出现坏死或穿孔的病例共
15 例 15 眼,根据角膜
炎累及角膜不同深度及范围以及前房反应等因素分别行板层或穿透性角膜移植