角膜板层清创联合无缝线羊膜移植术治疗表浅真菌性角膜炎

Clinical observation of corneal lamellar debridement combined with sutureless amniotic membrane transplantation for the treatment of superficial fungal keratitis

摘要:

目的：观察角膜板层清创联合无缝线羊膜移植术治疗表浅真菌性角膜炎的临床疗效。

方法：选取2012-04/2013-10在我院确诊的表浅真菌性角膜炎患者经局部+全身抗真菌药物治疗效果欠佳者22例22眼，采用角膜板层清创联合无缝线羊膜移植手术治疗，术中采用生物纤维蛋白粘合剂粘合固定羊膜植片。术后局部抗真菌治疗坚持1～2mo，随访3mo以上，裂隙灯观察角膜愈合、羊膜黏附等情况，共焦显微镜观察羊膜转归、真菌感染复发等。

结果：患者21例术后1～2wk角膜水肿、前房反应逐渐消退，未见羊膜植片脱落、溶解，未见羊膜下积液等； 2wk后羊膜植片逐渐与角膜融为一体，创面逐渐增厚，角膜上皮重建、透明度增加； 4wk后病变区逐渐瘢痕化，荧光素染色阴性； 3mo后角膜创面遗留程度不等的角膜云翳或斑翳，视力较术前有不同程度提高。其中19例术后4wk羊膜基本或完全吸收。术后1例真菌感染复发，经板层角膜移植后治愈。

结论：角膜板层清创联合无缝线羊膜移植可有效清除炎症病灶，提高局部药效，缩短手术时间，减轻术后反应，促进角膜愈合，是治疗表浅真菌性角膜炎的一种有效方法。

Abstract:

AIM:To evaluate the clinical efficacy of corneal lamellar debridement combined with sutureless amniotic membrane transplantation for the treatment of superficial fungal keratitis.

METHODS:Totally 22 cases(22 eyes)with superficial fungal keratitis were referred to our hospital from April 2012 to October 2013. The patients with persistent cornea ulcer after treatment of local and systemic antifungal drugs underwent corneal lamellar debridement combined with sutureless amniotic membrane transplantation, and the recipient bed was covered with an amniotic membrane using fibrin sealant during the operation. All patients were still given topical antifungal therapy for 1-2mo after operation. The followed-up time was 3mo or above. We observed the corneal healing and amniotic membrane adhesion by split lamp microscope, and investigated the transformation of amniotic membrane and fungal infection recurrence with confocal microscope.

RESULTS: Corneal edema and anterior chamber reaction of 21 patients disappeared gradually, and no amniotic membrane graft dissolved and shed off within 1-2wk postoperatively. Two weeks after operation, the graft integrated into the corneal and the corneal wounds' thickness increased gradually, the corneal epithelium reconstructed and corneas became clear. Four weeks after operation, the corneal scarring developed gradually and fluorescence staining was negative. Nineteen cases' amniotic membranes that adhered with the cornea dissolved 4wk after operation. There were different degrees of corneal nebula or macula remained 3mo postoperatively. All patients' vision improved in varying degrees, except in 1 case with fungal keratitis who had been cured by lamellar keratoplasty.

CONCLUSION:Corneal lamellar debridement combined with sutureless amniotic membrane transplantation can effectively remove the foci of inflammation, improve the local efficacy, shorten the operation time, relieve the postoperative reaction, and promote cornea union, which is an effective way to treat superficial fungal keratitis.