改良结膜瓣遮盖术治疗大泡性角膜病变观察  

Clinical observation of improved Conjunctival flap covering surgery for the Treatment of Cannon keratopathy

作　　者：刘丽丹[1] 余正星 

机构地区：[1]重庆市重钢总医院眼科,重庆400081

出　　处：《中国实用眼科杂志》2013年第6期769-771,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的为无复明要求的高龄大泡性角膜病患者寻求一种既能解除疼痛，又能改善视力的治疗方法。方法11例（11只眼）无复明要求，仅想解除疼痛的高龄大泡性角膜病患者，年龄68～92岁，平均（79．4~6．2）岁。术前全部视力〈0．05。病因：白内障患者行phaco＋IOL术后7例，植入前房型IOL8年后发病1例；青光眼患者行phaco＋IOL＋小梁切除术，术后3年发病1例；有小梁切除术和phaco＋IOL手术史，3年后出现单疱性角膜内皮病变1例；眼挫伤1例。行不作穹窿结膜切口，不作角膜板层切除的结膜瓣遮盖术。随访10～30月，平均（20．6＋6．3）月。结果11例患者术后结膜瓣覆盖好，呈半透明状，无疼痛、无复发，无上睑下垂等并发症发生。除2例术前已无光感者外，6例患者术后视力均有不同程度的提高，其中1例术后视力达0．08，3例患者术后视力≥0．05；2例术后视力无提高；1例术后早期能保留残存视力，18月后结膜瓣下纤维组织增生，视力减退至光感。结论改良后的结膜瓣遮盖术治疗大泡性角膜病能解除疼痛，防止复发，改善视力。尤其适用于伴有严重刺激症状，放弃复明希望的单眼高龄患者。Objective To find the way to relieve the pain and improve the residual vision for el- derly patients with cannon keratopathy and without vision rehabilitation requirement. Methods There were totally 11 patients （11 eyes）, with a mean age of 79.4±6.2 years （range, 68-92 years）, had suffered from cannon keratopathy and BCVA〈0.05, 7 was post phacoemulsification and IOL im- plantation surgery, 1 was post Phaco and IOL implantation combined with trabeculectomy surgery, 1 occurred in the 8 years post anterior chamber IOL implantation. 1 had ocular contusion, 1 had her- pes simplex keratitis in 3 years post Phaco and IOL implantation combined with trabeculectomy sur- gery and then to cannon keratopathy. Conjunctival flap covering surgery was performed without forni- cal conjunctiva and lamellar resection wascompleted in these cases. The period of follow up time was 10 to 30 months. Results Postoperatively, conjunctival flap was translucence in all the 11 cas- es, without ptosis, relapses and pain. UCVA of 2 patients was NLP pre the operation, 2 patients kept the preoperative level, 6 patients （66.7%） gained different levels of vision improvement （UCVA post-op was ≥0.05 in 3 cases and 0.08 in 1 case）. 1 patient kept the preoperative level but de- creased to LP in 18 months post surgery because of the fibroplasticproliferation under conjunctival flap. Conclusions Improved conjunctival flap covering surgery is effective for cannon keratopathy. The major advantages compared with other techniques are preservation of residual vision, pain remis- sion and reduce relapsing, especially for those elderly patients with severe ocular irritation and with- out vision rehabilitation requirement.

关 键 词：大泡性角膜病变 结膜瓣遮盖术 

分 类 号：R772.210.5[医药卫生—眼科]