结膜瓣遮盖术治疗难治性角膜溃疡  

Application of conjunctival flap covering surgery in treatment of refractory corneal ulcer

作　　者：雷光明[1] 王喜梅[1] 张新萍[1] 李波 

机构地区：[1]鹤壁职业技术学院,河南省鹤壁市458030 [2]郑州同仁眼科医院,河南省郑州市450000

出　　处：《眼科新进展》2011年第9期883-885,共3页Recent Advances in Ophthalmology

摘　　要：目的探讨应用结膜瓣遮盖术治疗难治性角膜溃疡的临床疗效。方法选取22例(22眼)难治性角膜溃疡患者,其中单纯疱疹病毒性角膜溃疡4眼,真菌性角膜溃疡7眼(发生角膜穿孔2眼),细菌性角膜溃疡8眼,严重的化学烧伤1眼,穿透性角膜移植术后植片溃疡2眼。所有患者均进行局部病灶清除+结膜瓣遮盖术,并针对原发病进一步药物治疗。术后随访3～6个月,观察结膜瓣血供、前房及视力等情况。结果 20眼(包括2眼角膜穿孔眼)角膜溃疡1次手术后治愈;2眼术后结膜瓣溶解脱落,其中1眼细菌性角膜溃疡眼行再次结膜瓣遮盖术后治愈;另1眼真菌性角膜溃疡眼反复2次行结膜瓣遮盖术,感染未控制,最终发生结膜瓣自溶。21眼视力不变或提高,其中光感5眼,数指～0.1者12眼,0.2～0.5者5眼。21眼前房形成良好,眼压基本正常。结论只要手术适应证选择适当、手术操作细致,结膜瓣遮盖术是治疗难治性角膜溃疡的有效方法之一。Objective To discuss the clinical effect of conjunctival flap covering surgery in treatment of refractory corneal ulcer.Methods Twenty-two patients with refractory corneal ulcer were chosen,including 4 cases with herpes simplex virus corneal ulcer,7 cases with fungal corneal ulcer（2 cases with corneal perforation）,8 cases with bacterial corneal ulcer,1 case with serious chemical burn,2 cases with corneal graft ulcer after penetration keratoplasty.All patients received the focus lesion clearance and conjunctival flap covering surgery,and the symptom was treated according to the primary disease.The follow-up time was from 3 months to 6 months,the visual acuity,anterior chamber and blood supply of conjunctival flap were observed.Results Twenty patients were cured after the primary treatment,the corneal flap dissolved and separated in 2 cases,in which 1 case with bacterial corneal ulcer was cured after re-conjunctival flap covering surgery,the other case received the 2 times conjunctival flap covering surgery,but the infection was not controlled,eventually conjunctival flap autolysis occurred.The visual acuity in 21 cases was unchanged or improved,in which 5 cases with light perception,from finger counting to 0.1 in 12 eyes,from 0.2 to 0.5 in 5 eyes.The anterior chambers were formed in 21 cases,the intraocular pressure was ordinary normal.Conclusion In the condition of proper selecting the appropriate indications and carefully operating,the conjunctival flap covering technique is one of the effective methods for treating the refractory corneal ulcer.

关 键 词：结膜瓣遮盖术 难治性角膜溃疡 病灶切除 

分 类 号：R777.2[医药卫生—眼科]