板层角膜移植术联合快速角膜胶原交联治疗难治性真菌性角膜溃疡

Clinical efficacy of lamellar keratoplasty combined with acelerated corneal collagen cross-linking on refractory fungal corneal ulcer

摘要:

目的：观察板层角膜移植术联合快速角膜胶原交联治疗难治性真菌性角膜溃疡的临床效果。

方法：选取2017-01/2018-11在江西医专一附院眼科就诊收住院行板层角膜移植术联合快速角膜胶原交联术治疗的真菌性角膜溃疡的患者18例18眼，对治疗效果进行回顾性分析。观察术后视力、角膜植片透明度的情况及真菌复发、移植片排斥、继发性青光眼、并发性白内障等并发症的发生概率和预后。

结果：术后18例患者全部保全了眼球，术后裸眼视力提高者16眼(89%)，视力不变者2眼(11%)，角膜移植片发生排斥反应3眼(17%)，继发性青光眼2眼(11%)，并发性白内障3眼(17%)。植片透明的患者为13眼(72%)，植片半透明4眼(22%)，植片混浊1眼(6%)。

结论：板层角膜移植术联合快速角膜胶原交联治疗难治性真菌性角膜溃疡能提高真菌性角膜溃疡治愈率，是一种切实可行的治疗方法。

Abstract:

AIM: To investigate the efficacy of lamellar keratoplasty(LKP)combined with accelerated(45mW/cm²)corneal cross-linking(A-CXL)on refractory fungal corneal ulcer.

METHODS: Eighteen eyes of 18 patients with refractory fungal corneal ulcer were enrolled in the Department of Ophthalmology, First Affiliated Hospital of Jiangxi Medical College from January 2017 to November 2018. The postoperative visual acuity, corneal graft transparency, the incidence and prognosis of complications such as fungal recurrence, graft rejection, secondary glaucoma and complicated cataract were all recorded.

RESULTS: All the patients succeeded in avoiding enucleation or evisceration. Postoperatively, 16 eyes(89%)gained one or more lines in uncorrected distance visual acuity 2 eyes(11%)had unchanged in uncorrected distance visual acuity. Three eyes(17%)had a graft rejection. Secondary glaucoma were detected in 2 eyes(11%), and concomitant cataract were found in 3 eyes(17%). Thirteen eyes(72%)had transparent grafts, 4 eyes(22%)had translucent transects, and the remaining one eye(6%)had a turbid graft.

CONCLUSION: LK combined with A-CXL may be feasible for refractory fungal corneal ulcer treatment by improving the cure rate.