结膜瓣遮盖术治疗难治性角膜溃疡疗效观察  

The observation of curative effects of conjunctival flap covering surgery in treatment of refractory corneal ulcer

作　　者：郭晓飞[1] 肖青[1] 肖凤枝 郑素慧[1] 张小利[1] 

机构地区：[1]唐山市眼科医院,唐山063000

出　　处：《中国实用眼科杂志》2016年第7期735-737,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察结膜瓣遮盖术治疗难治性角膜溃疡的临床疗效。方法回顾分析2013年1月至2015年1月在唐山市眼科医院实施结膜瓣遮盖术治疗的难治性角膜溃疡40例40只眼。其中，细菌性角膜溃疡15只眼，真菌性角膜溃疡18只眼，病毒性角膜溃疡4只眼，神经麻痹性角膜溃疡3只眼。溃疡迁延不愈，所有患者均进行角膜病灶切除＋结膜瓣遮盖术，术后继续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，角膜溃疡愈合及术后视力等情况。结果37例37只眼1次手术治愈。3例3只眼出现结膜瓣回退，结膜瓣溶解脱落，其中2只眼（1只眼细菌角膜溃疡、1只眼基质坏死型单纯病毒性角膜溃疡）实施角膜移植术后治愈，1只眼真菌性角膜溃疡穿孔合并眼内炎，最终实施眼球摘除术。随访3-6个月，术后视力：39只眼维持原视力或部分提高。其中手动／眼前。指数／眼前有18只眼，指数～0．1有5只眼，0．12—0．4有16只眼。结论对于药物治疗无效的难治性角膜溃疡，结膜瓣遮盖术是有效的治疗方法，为复明手术奠定了基础。Objective To study the clinical curative effect of conjunctival flap covering surgery in treatment of refractory corneal ulcer. Methods Forty patients （40 eyes） with refractory corneal ulcer that underwent conjunctival flap covering surgery were retrospectively analyzed, including 15 cas- es with bacterial corneal ulcer, 18 cases with fungal corneal ulcer, 4 cases with viral corneal ulcer, 3 cases with neuroparalytic corneal ulcer. All the patients were treated with removal of the necrotic corneal tissue combined with conjunctival flap coveting surgery when the corneal ulcer was protracted course of disease. And the medical therapy was further used to treat the primary disease after the operation. The follow-up time was from 3 months to 6 months, and the visual acuity, conjunctival flap and the healing of the corneal ulcer were observed. Results Thirty-seven eyes with corneal ulcer were cured after the operation treatment, the rollback and dissolution of conjunctival flaps was happened in three cases, in which 1 case with bacterial corneal ulcer and 1 case with necrotizing herpes simplex stromal keratitis were eventually cured after corneal transplantation surgery. One case with fungal corneal ulcer combined with perforation and endoophthalmitis was underwent ophthalmectomy eventually. The follow-up time was from 3 months to 6 months, Visual acuity： The visual acu- ity in 39 cases was unchanged or partially improved, in which 18 cases were improved from light perception to counting finger, 5 eyes from counting finger to 0.1, 16 eyes from 0.12 to 0.4. Conclusions Conjunctival flap covering surgery is effective in treatment of refractory corneal ulcer which has not responded to medical therapy. In a certain extent, it can save the eyeball and provide the further condition for comeal transplantation operation.

关 键 词：结膜瓣遮盖术 难治性角膜溃疡 

分 类 号：R772.21[医药卫生—眼科]