病灶切除联合冷凝及羊膜覆盖手术治疗重症真菌性角膜溃疡

目的观察病灶切除联合冷凝及羊膜覆盖手术治疗重症真菌性角膜溃疡的效果。方法手术治疗真菌性角膜溃疡17例（17眼）,病程20d～3个月。溃疡面积〈5mm者3例,≥5mm者14例,溃疡深达角膜实质层1／3～1／2角膜厚度,有9例伴有前房积脓。所有病例均经角膜涂片或培养查到真菌。术后随访时间3～12个月。结果11例术后炎症控制,角膜创面清洁,1个月内逐渐愈合。6例炎症未被控制,前房积脓不见吸收,或吸收后复又出现,最后行穿透性角膜移植术。羊膜一般于1周后逐渐融解。溃疡愈合者大多保留了一定的视力：数指／30cm～0．2。结论对于药物治疗未能控制、病情继续恶化的重症真菌性角膜溃疡,及时联合手术治疗,可促进溃疡愈合,保存眼球完整性,为角膜移植提供机会。因各种原因暂不能行角膜移植的情况下,病灶切除联合冷凝及羊膜覆盖不失为一种较为有效的方法。

Focal lesion keratectomy combined with cryotherapy and biological amnion covering in the management of fungal corneal ulcer

Objective To examine the efficacy of focal lesion keratectomy combined with cryotherapy and biological amnion covering in the management of fungal corneal ulcer. Methods Seventeen patients (17 eyes) with fungal corneal ulcer were treated with focal lesion keratectomy combined with cryotherapy and biological amnion covering between January 2009 and October 2009. The course of diseases was 20 days to 3 months (36.1±16.3 days), There was a a<5 mm corneal ulcer in the 3 cases, there was a>5 mm corneal ulcer in the 14 cases. 9 cases(9 eyes)of 17 patients had hypopyon. We investigated the healing of corneal ulcer and covering of amniotic membrane with slit lamp microscope, complications and ulcer recurrences were analysed. Results All the cases were followed up for 3 to 12 months after operation of them, Fungal infection were controlled and corneal ulcer healed within 3-4 weeks postoperatively in 11 patients, 6 cases were carried out penetrative keratoplasty because of the uncontrolled keratomycosis. Superficial amniotic membrane patches dissolved or shed on postoperative 7-10 days. No complication occurred. Conclusion Focal lesion keratectomy combined with cryotherapy and amniotic membrane covering is an effective method in the a part of patients with fungal corneal ulcer .