难治性化脓性角膜溃疡的姑息性手术治疗

Palliative surgery for refractory purulent corneal ulcer

摘要:

目的：探讨异体巩膜移植联合自体结膜瓣遮盖术治疗难治性化脓性角膜溃疡的临床效果。

方法：采用回顾性分析，选择2015-06/2017-06因化脓性角膜溃疡入院患者20例20眼，药物治疗无效，无法行穿透性角膜移植而行异体巩膜移植联合自体结膜瓣遮盖术治疗，观察此种姑息手术的术中并发症、术后巩膜和结膜瓣生长、术后并发症等情况。

结果：20例20眼患者中，18眼异体巩膜和结膜瓣生长良好，治愈率90%，1眼结膜瓣愈合不良行羊膜移植手术修复，1眼因玻璃体腔感染较重、感染复发行眼内容物剜除术； 术中晶状体脱出2眼(10%)，均予以摘除； 3眼(15%)患者术后出现继发性青光眼，行睫状体冷冻术治愈。

结论：异体巩膜移植联合自体结膜瓣遮盖术是一种姑息性手术方法，是控制药物治疗无效而又无法行穿透性角膜移植手术的严重化脓性角膜溃疡患者眼部感染并保持其眼球外形的有效方式，可替代以往的眼内容物剜除术以控制感染，既可避免患者失去眼球带来的眼部病痛和心理创伤，又为后期改善外观节省费用。

Abstract:

AIM:To investigate the clinical effect of scleral allograft combined with conjunctival flap autograft for refractory purulent corneal ulcer.

METHODS: Twenty patients(20 eyes)with purulent corneal ulcer admitted to our hospital during June 2015 to June 2017 were selected. The results showed that the drug treatment was not effective and could not be performed by penetrating keratoplasty, and then allogeneic scleral transplantation combined with conjunctival flap autograft covering was performed. A retrospective analysis was carried out. The intraoperative complications, postoperative scleral and conjunctival flap growth and postoperative complications of this palliative operation were observed.

RESULTS: Of the 20 patients, 18 had good growth of sclera and conjunctival flap, the cure rate was 90%. One case had bad healing of conjunctival flap and was cured by amniotic membrane transplantation; 1 case had enucleation because of severe vitreous cavity infection; 2 cases had lens prolapse, the incidence rate was 10%. Secondary glaucoma occurred in 3 cases with an incidence of 15%, which was cured by cryociliary surgery.

CONCLUSION:Scleral allograft combined with conjunctival flap autograft is a palliative operation. It is an effective way to control the corneal infection and maintain the appearance of the eyeball in the patients with severe purulent corneal ulcer, which is ineffective in drug treatment and unable to perform penetrating keratoplasty. It can replace the previous enucleation of the eye contents to control the infection. It can not only avoid the eye pain and psychological trauma caused by the loss of eyeball, but also save money for improving the appearance in the later stage.