真菌性角膜溃疡穿孔眼内容剜除术后羟基磷灰石义眼座植入5例  

Hydroxyapatite artificial eye pedestal implantation after evisceration for 5 cases of mycotic corneal ulcer pene-tration

作　　者：毛海燕[1] 赵普宁[1] 欧波[1] 王开丽[1] 

机构地区：[1]海南省人民医院眼科,中国海南省海口市570311

出　　处：《国际眼科杂志》2005年第2期366-368,共3页International Eye Science

摘　　要：目的:观察真菌性角膜溃疡穿孔行眼内容剜除,术后I期植入羟基磷灰石(HA)义眼座的临床疗效。方法:真菌性角膜溃疡穿孔患者5例,按常规行眼内容剜除术,安尔碘或碘酒涂擦巩膜腔,生理盐水冲洗,氟康唑液冲洗巩膜腔。球后剪断视神经,从颞上向鼻下将巩膜壳剪为两半,把HA义眼座植入肌锥部,对缝巩膜形成双层巩膜帽覆盖在HA义眼座前部,逐层缝合筋膜及结膜,术后继续用抗真菌药物治疗。结果:观察时间0.5～3a,未再见有真菌感染。在5例中有1例术后结膜水肿,结膜囊有脓性分泌物,涂片找到真菌,经用氟康唑液冲洗结膜囊及全身应用抗真菌药物后分泌物逐渐减少。全部病例结膜愈合良好,未见HA义眼座排出及感染。结论:真菌性角膜溃疡穿孔行眼内容剜除术后,I期植入HA义眼座,术后配合抗真菌药物治疗,安全可行,术后达到了眼窝整形与美容的效果。s· AIM: To observe the clinical effects of hydroxyapatite artificial eye pedestal implantation after evisceration for patients of mycotic corneal ulcer penetration when it is impossible to cure them by keratoplasty.· METHODS: Evisceration was done conventionally on 5 patients with mycotic corneal ulcer penetration. Scleral cavity was rubbed with iodine, washed with N.S. and fluconazole fluid. Optic nerve was cut, and sclera was halved from temperal superior to nasal inferior. The HA eye pedestal was implanted into muscle cone, and sclera was sutured to form two-layer sclera cap which covered the front of the HA eye pedestal. Anti-fungus drugs were used postoperatively.· RESULTS: In 1 of the 5 cases, the conjunctiva swelled, pus was discharged in the conjunctiva sac and fungi were found. Secretion decreased gradually after the conjunctiva sac was washed with fluconazole fluid and anti-fungus drugs were applied systemically. Conjunctivae in all cases healed well. There was no HA artificial eye pedestal out or infection.· CONCLUTION: After evisceration was carried out for patients with mycotic corneal ulcer penetration, implantation of HA eye pedestal should be performed with the combination of anti-fungus drugs at the first stage. This method is safe and feasible, and it conforms to the physiological function of eyeball.·

关 键 词：真菌性角膜溃疡穿孔 羟基磷灰石义眼座植入 抗真菌药物治疗 羟基磷灰石(HA) HA义眼座植入 眼内容剜除术 生理盐水冲洗 Ⅰ期植入 脓性分泌物 临床疗效 观察时间 真菌感染 结膜水肿 全身应用 术后配合 眼窝整形 巩膜腔 氟康唑 

分 类 号：R779.64[医药卫生—眼科]