方法：对35例35眼大泡性角膜病变者施行角膜基质针刺联合羊膜移植术，所有患者术前、术后均行前节OCT、角膜地形图、角膜知觉、共焦显微镜检查。观察患者术后眼部症状、大泡复发情况、角膜知觉改变、角膜厚度变化、角膜各层组织结构变化。

结果：角膜基质针刺联合羊膜移植术后随访6～18mo。32例(91%)均在术后第1d疼痛感消失，并在随访期间未再出现疼痛，另外3例(9%)疼痛感减轻并在3d后消失。9例(26%)术后角膜上皮在1wk内愈合，21例(60%)在2wk内愈合，5例(14%)在3wk内愈合。随访期间BK无复发，2例(6%)在术后3，4wk在周边区域见少量微小水泡，无自觉症状，随时间延长未见加重。所有患者无新生血管发生，角膜表面光滑。30例(86%)移植的羊膜于术后2mo变薄，部分溶解吸收，3mo时肉眼基本不见羊膜。34例(97%)视力无改变，1例(3%)由光感到手动/眼前。30例(86%)术后2mo角膜知觉减退，下降幅度为20±7mm，所有患者角膜厚度均增加，由术前的788±35μm，增至940±43μm，术后12mo，角膜厚度增至1 060±27μm。共焦显微镜结果：术后3mo，角膜基底膜下三叉神经纤维数量密度降低，浅基质层基质细胞成纤维化，深基质层更加疏松、细胞肿胀明显，内皮细胞数量较术前减少且肿胀更加明显。

结论：角膜基质针刺联合羊膜移植术能有效控制BK的症状，防止BK的复发，尤其是对症状明显，视功能差的患者是简单、安全、实用的方法。

METHODS: Totally 35 patients(35 eyes)with bullous keratopathy were treated by corneal stromal acupuncture combined with amniotic membrane transplantation. All patients preoperative and postoperative underwent anterior segment OCT, corneal topography, corneal sensitivity and confocal microscopy. To observe postoperative ocular symptoms in patients with BK, recurrence of bulla, changes in corneal thickness, corneal sensitivity and changes in the organizational structure of the layers of the cornea.

RESULTS: Thirty-five were followed up for 6-18mo. The symptom of pain disappeared in 32 cases(91%)in the first day after operation and did not recur during follow-up. The symptom of pain relieved in 3 cases(9%)in the first day after operation and disappeared in 3 days. Corneal epithelium of 9 cases(26%)were all healed within 1wk, 21 cases(60%)were all healed within 2wk, and 5 cases(14%)were all healed within 3wk. Following up for 6-18mo, there was no recurrence of symptoms or bulla. A small amount of tiny bubbles in the surrounding area appeared in 2 cases after 3 and 4wk. All patients had no neovascularization, and had smooth corneal surface. The amnions of 30 cases(86%)were thinning after 2mo, partially dissolved and absorped, not seen with the naked eye after 3mo. Thirty-four cases(97%)had no changes in vision, one case(3%)was from the light to front of the manual. After 2mo, corneal sensation decreased in 30 cases(86%), corneal thickness increased from preoperative 788±35μm to 940±43μm. After 12mo, corneal thickness increased to 1060±27μm. Results of confocal microscopy: after 3mo, the number density of the trigeminal nerve fibers under corneal basement membrane reduced, shallow stromal cells became into fibrotic stroma, deep stroma was more loose, and cells swelled significantly. The number of endothelial cells reduced and form swelled more obviously compared with preoperatively.

CONCLUSION: Corneal acupuncture combined with amniotic membrane transplantation can effectively control the symptoms of BK, prevent the recurrence of BK, and especially it is a simple, safe and practical way for patients with poor visual function.