羊膜卷填塞联合双层羊膜遮盖治疗角膜溃疡穿孔  

Amniotic bysma plugging combined with bilayer amniotic membrane cover for treatment of corneal ulcer with perforation

作　　者：范军华[1] 李学喜[1] 潘栋平[1] 

机构地区：[1]泉州市解放军第180医院眼科医院,福建362000

出　　处：《中国实用眼科杂志》2012年第1期85-88,共4页Chinese Journal of Practical Ophthalmology

基　　金：基金资助：南京军区“十一五”医药卫生基金资助课题（06MA105）

摘　　要：目的探讨羊膜卷填塞联合双层羊膜遮盖治疗角膜溃疡穿孔的临床效果。方法选择2007年7月至2010年4月收治的角膜溃疡穿孔患者11例11只眼，溃疡直径2—4mm，穿孔直径0．5—2mm，采取羊膜卷填塞联合双层羊膜遮盖以及前房C3F8隋性气体填充手术，术后继续抗感染及对症治疗，观察角膜溃疡愈合情况及羊膜卷转化情况，随访6—18个月，平均11个月。结果11例11只眼术后前房形成好，C3F8气泡存在时间约5～12d，无房水渗漏，羊膜卷无脱出或掉入前房。术后2个月后溃疡表面双层羊膜大部溶解吸收，溃疡内填塞之羊膜卷与角膜组织逐渐融合，无房水渗漏，瞳孔无前粘，羊膜卷缓慢溶解变小，并逐渐被增生的角膜纤维结缔组织填充，手术6个月后羊膜卷完全被疤痕组织替代，角膜白斑处无新生血管侵入。术后所有患者视力均得到提高。结论羊膜卷填塞联合多层羊膜遮盖以及前房C3F8隋性气体填充手术治疗角膜溃疡穿孔能保住患眼，恢复部分视力，简便易行，效果较好。Objective To evaluate the efficacy of amniotic bysma plugging combined with bilayer amniotic membrane cover to treat comeal ulcer with perforation. Methods Eleven patients （11 eyes） of corneal ulcer with perforation were referred in our hospital between July 2007 and April 2010. The diameter of all corneal ulcers were 2-4mm, the diameter of perforations were 0.5-2ram. The biological amnions preserved by freezing Glycerol were rolled to be a bysma before operation. Amniotic bysma plugging combined with bilayer amniotic membrane cover was performed to mend the corneal perforation, and C3F8 gas was filled in anterior chamber to keep the depth of the anterior chamber. The healing of corneal ulcer and transformation of amniotic bysma were observed with slit lamp biomicroscope. All patients were followed up for 6-18 months （mean 11 months）. Resuits After the surgery, all patients had normal anterior chamber depth without amniotic bysma breaking off or anqueous leak. The C3F8 gas can stay in the anterior chamber for 5-12 days. Superficial bilayer amniotic membrane patches dissolved or shed about 2 weeks after operation. The amniotic bysma dissolved and was replaced slowly by new comeal connective tissue from 2 to 6 months after operation. No neovascularization invading into the comeal scar. The visual acuity was all below 0.1 before surgery and improved 6 months after surgery. Conclusions The operation of amnion bysma plugging combined with bilayer amniotic membrane cover and C3F8 tamponade in anterior chamber is a safe, easy-operated and effective method to treat corneal ulcer with perforation, and can save and improve visual acuity mostly.

关 键 词：角膜溃疡 穿孔 生物羊膜 填塞 C3F6隋性气体 前房填充 

分 类 号：R779.65[医药卫生—眼科]