软性角膜接触镜治疗角膜溃疡穿孔的临床观察

目的:观察软性角膜接触镜治疗角膜溃疡穿孔的临床疗效。方法:对24例24眼角膜溃疡穿孔的患者采用配戴软性角膜接触镜治疗。其中细菌性14例14眼,病毒性8例8眼,真菌性2例2眼。戴镜期间根据不同病因选择联合用药,角膜镜配戴1wk清洗,3wk更换,角膜愈合后摘镜,随诊复查。结果:角膜溃疡穿孔患者24例24眼戴镜后1～2d前房均形成,5～10d后角膜上皮覆盖,角膜基质层纤维网状支架形成,20～32d角膜溃疡愈合,穿孔区密闭良好。患者视力有不同程度提高。结论:软性角膜接触镜是一种安全有效的角膜溃疡穿孔的辅助治疗方法。     

软性角膜接触镜在角膜溃疡穿孔中的应用

目的 :评价软性角膜接触镜在角膜溃疡穿孔中的效果。方法 :选择本院角膜溃疡穿孔的患者 2 2例 2 2眼 ,细菌性 3例 3眼 ,病毒性 4例 4眼 ,真菌性 9例 9眼 ,其它 6例 6眼。所有患者均配戴软性角膜接触镜治疗。戴镜期间根据不同病例选择用药 ,接触镜每隔 14或 3 0天消毒一次。结果 :治疗后 1～ 3天 2 2眼前房均基本恢复 ,2 1～ 3 2天角膜穿孔区闭合 ,角膜炎症基本控制。随访 2～ 14个月 (平均 4个月 ) ,2 2眼视力均有不同程度提高。但对于视力 <0 1的患者可行角膜移植术 ,并减少并发症 ,提高其成功率。结论 :软性角膜接触镜治疗角膜溃疡穿孔较安全 ,具有促进穿孔愈合的效果。     

羊膜填塞法联合配戴软性角膜接触镜治疗角膜溃疡穿孔

目的:观察羊膜填塞法联合配戴软性角膜接触镜治疗角膜溃疡性穿孔的临床效果,了解此方法的有效性、安全性和局限性。方法:对11例(11眼)感染性角膜溃疡穿孔的患者采用羊膜填塞治疗。其中,真菌性角膜溃疡穿孔3眼,病毒性角膜溃疡穿孔2眼,细菌性角膜溃疡穿孔5眼,单疱病毒性合并细菌感染者1眼。溃疡穿孔范围0.5～2mm。用羊膜填塞穿孔、用另一羊膜覆盖于整个角膜表面,配戴软性角膜接触镜。结果:术后1d,11例患者前房均形成,穿孔区密闭良好,随访期间前房深度正常。手术后6wk有完好上皮覆盖,穿孔区角膜厚度逐渐增加,溃疡周边炎症反应减退。术后5mo溃疡瘢痕愈合,溃疡区的角膜厚度稳定。11眼术后视力均有不同程度提高。随访期间未出现复发及严重的并发症。结论:羊膜填塞法联合配戴软性角膜接触镜治疗<2mm的角膜溃疡性穿孔是有效、安全的,但此方法术后角膜溃疡是瘢痕愈合,适用于穿孔区非角膜中央的患者。     

Viscoat黏弹剂联合软性角膜接触镜治疗角膜中央穿孔

目的 探讨Viscoat黏弹剂联合软性角膜接触镜治疗角膜中央穿孔的临床疗效.方法 收集我院眼科就诊的6例角膜中央穿孔患者的临床资料,角膜穿孔的直径均不超过2.0 mm,行角膜局部清创并在前房内注入Viscoat,然后予以配戴软性角膜接触镜,随访2～3个月,记录患者主观感觉、视力、裂隙灯检查、眼压、活体共聚焦显微镜、角膜内皮细胞计数等以判断疗效.结果 所有病例均达到治愈,治疗时长为1～2个月;最佳矫正视力提高至0.6～0.8,角膜内皮细胞计数为(3415.5±279.5)个·mm-2,角膜未留明显瘢痕,无严重并发症发生.结论 对于直径≤2.0 mm的外伤性角膜中央穿孔可通过应用Vis-coat黏弹剂联合软性角膜接触镜治疗,预后良好,并且减轻了患者的经济负担.     

生物羊膜联合治疗性角膜软接触镜治疗角膜溃疡

目的:探讨角膜溃疡患者行生物羊膜联合治疗性角膜软接触镜的治疗效果及可行性。方法:对33例35眼角膜溃疡患者进行削除病变组织,在植床平铺与溃疡面大小相仿生物羊膜(溃疡较深行多层羊膜覆盖填塞),将稍大于溃疡灶的外层生物羊膜与周围正常角膜组织间断缝合,术后第2d配戴治疗性角膜软接触镜,并针对不同病因的角膜溃疡点用治疗性眼药水。结果:所有患者1～2d内恢复前房,1wk左右局部刺激症状明显好转,溃疡平均愈合时间30～45d,5例患者见新生血管长入,角膜不同程度的瘢痕形成,2例角膜溃疡前房反复消失,后行穿通性角膜移植。治疗后视力均有不同程度的提高。结论:此方法能有效修复角膜溃疡组织,为后期角膜移植创造良好的局部条件。     

板层角膜移植联合自体角膜瓣填垫治疗边缘性角膜穿孔

目的:探讨用自体角膜瓣封闭角膜穿孔,联合板层角膜移植治疗边缘性角膜溃疡穿孔的临床疗效。方法:对17例(17眼)不同病因引起的边缘性角膜溃疡穿孔患者行自体角膜瓣填垫及板层角膜移植,术后对植片愈合、虹膜前粘连、继发青光眼、视力、免疫排斥反应进行观察。结果:随访3～12(平均6)mo,所有患者植片透明,未见排斥反应,层间积液2例至术后1mo吸收,前房轴深正常,虹膜粘连于角膜穿孔处3例,无继发青光眼。随访>3mo,视力较术前提高12眼,无进步5眼。结论:板层角膜移植联合自体角膜瓣填垫是治疗边缘性角膜穿孔的有效方法。     

绷带式角膜接触镜在板层角膜切除术治疗真菌性角膜溃疡中的应用

目的　探讨板层角膜切除术联合绷带式角膜接触镜及局部和全身应用抗真菌药物治疗真菌性角膜溃疡的效果。方法　收集2015年1月至2017年6月于我院确诊为真菌性角膜溃疡的患者49例49眼,所有患眼均为感染范围在8 mm以内、感染深度小于1/3角膜厚度者,均行板层角膜切除术,根据术后处理方法不同分为两组,观察组29例29眼使用抗真菌药物联合绷带式角膜接触镜治疗,对照组20例20眼仅给予抗真菌药物治疗。观察两组术后角膜上皮愈合时间、眼睑刺激症状消失时间,记录术后1 d、7 d、14 d、1个月、3个月及6个月的裸眼视力（uncorrected visual acuity,UCVA）和最佳矫正视力（best corrected visual acuity,BCVA）。结果　观察组角膜上皮愈合时间为5~13（9.03±2.31）d,对照组为12~33（19.95±5.55）d,两组相比差异有统计学意义（t=-9.504,P=0.040）。术后观察组患者各随访时间点的UCVA均超过术前BCVA,且安全性指数(术后BCVA /术前BCVA)及有效性指数（术后UCVA/术前BCVA）均远远大于1,对照组术后1~14 d因角膜刺激症状安全性指数未计算,但有效性指数均略大于1,其他各时段安全性指数和有效性指数均明显大于1。观察组眼睑刺激症状消失时间为（1.19±0.95）d,对照组为（16.90±5.05）d,两组相比差异有统计学差异（t=-16.424,P<0.001）。术后3个月、6个月角膜瘢痕遗留情况观察组均优于对照组,差异均有统计学意义（均为P＜0.05）。结论　绷带式角膜接触镜在板层角膜切除术治疗真菌性角膜溃疡中可以有效缩短患者角膜上皮愈合时间,提高患者生存质量,术后尽早地改善了患者视力。     

角膜穿孔伤的屈光性缝合手术

目的　探讨角膜穿孔伤手术缝合中运用辅助手段减轻术后角膜散光 (屈光性缝合 )的方法。方法　术中采用黏弹剂、缩瞳剂、辅助切口及相应的缝合技巧 ;术后合理应用治疗性角膜软性接触镜。结果　 10 8例 10 9眼术后角膜创口愈合良好 ,瘢痕小 ,不规则散光减轻 ,其中 49眼术后健眼与患眼角膜地形图参数值显示差异无显著性意义 (P >0 .0 5 )。结论　角膜穿孔伤创口修复时采用相应的辅助手段能有效减轻术后角膜散光状态 ,重建原有的角膜外形     

软性角膜接触镜对角膜穿孔伤的疗效观察

角膜穿孔伤是一种常见的眼病,其治疗原则是迅速清理、缝合创口、防止感染及其它合并症。我们对单纯性角膜穿孔伤不作缝合,不进行眼局部抗生素注射,采用软性角膜接触镜浸泡庆大霉素进行治疗。自1986年5月至1988年5月,共治疗角膜穿孔伤患者21例21眼,获得满意效果。报道如下。     

长期配戴角膜接触镜角膜中央厚度的变化

目的探讨长期持续配戴软性角膜接触镜者和长期配戴硬性透氧性接触镜(rigidgas-permeablecontactlens,RGP)者与无角膜接触镜配戴史者中央角膜厚度的差异。方法应用超声角膜测厚仪检测无角膜接触镜配戴史者500例(918眼)、长期持续配戴软性角膜接触镜2年以上200例(386眼)和长期配戴RGP≥1年者100例(195眼)的中央角膜厚度。结果无角膜接触镜配戴史者,平均角膜中央厚度为(528.59±23.37)μm,长期持续配戴软性角膜接触镜者平均中央角膜厚度为(512.31±21.73)μm,配戴RGP者平均中央角膜厚度为(515.03±22.97)μm。配戴软性角膜接触镜者与正常者比较,差异有显著性(P<0.05)。配戴RGP者与正常者比较,差异有显著性(P<0.05),配戴软性角膜接触镜者与RGP者比较,差异无显著性(P>0.05)。结论长期持续配戴软性角膜接触镜者和RGP者平均中央角膜厚度均薄于无角膜接触镜配戴者。     

Use of human fibrin glue and amniotic membrane transplant in corneal perforation

PURPOSE: To repair corneal perforation using human fibrin glue (HFG) and amniotic membrane transplant (AMT). METHODS: Three patients in whom central corneal perforations, approximately 2 mm in diameter, occurred after ocular or systemic disease were successfully cured using HFG and AMT. The technique consists first of using a high-viscosity sodium hyaluronate viscoelastic material to restore anterior chamber depth followed by a debridement of the ulcer. The perforation site is filled with the HFG to corneal surface level. The so-formed plug is then secured with an AMT to avoid its extrusion. An extended-wear bandage contact lens and topical antibiotics were used in these patients for 3 weeks. RESULTS: Total reepithelialization was observed after an average of 15 postoperative days. The AMT dissolved within 8 weeks to uncover a whitish scar formed within the perforation sites. No complications were observed in any patients. After a follow-up period of 195-325 days, all corneas remained stable; there was no infection or ulcer recurrence, but some corneal scar thinning was observed in all three cases. CONCLUSION: The described surgical approach using HFG and AMT allowed a successful repair of corneal perforations with a diameter of 2 mm associated with significant loss of stroma. This method may be a good alternative to delay penetrating keratoplasty for treating corneal perforations, especially in acute cases in which graft rejection risk is high. eal     

Simultaneous penetrating keratoplasty, cataract extraction and artificial lens implantation ("triple procedure") 1981-1987

Between June 1981 and March 1987, the authors performed simultaneous penetrating keratoplasty, cataract extraction, and intraocular lens implantation in 90 eyes. The main indications were Fuchs's corneal endothelial dystrophy (38 cases), corneal cicatrization (33 cases) and corneal or scleral perforation (7 cases). Extracapsular cataract extraction with posterior chamber lens implantation was performed in 82 patients. The posterior capsule ruptured in nine eyes, necessitating an anterior vitrectomy in four of them. The corneal transplant was rejected in nine eyes (10%). The mean preoperative visual acuity of 9/100 in 89 patients improved to 39/100 six months after surgery in 59 patients who were followed up and to 50/100 in the 29 patients with Fuchs's corneal dystrophy. The authors believe that in cases presenting with both cataract and medically uncontrollable corneal disease, simultaneous penetrating keratoplasty with extracapsular cataract extraction and implantation of a posterior chamber lens represents the treatment of choice.     

深板层角膜移植联合自体角膜层间垫片术对角膜穿孔的临床应用价值

目的:探讨深板层角膜移植联合自体角膜层间垫片术治疗角膜穿孔的临床效果。方法:采用系列病例观察研究,收集2017年1月至2018年8月于河南省人民医院眼科就诊的角膜穿孔患者14例14眼,所有患者均行深板层角膜移植术,术中取自体角膜基质片填垫于角膜穿孔处。分别于术后第1、7、14天,第1、3、6、9、12个月记录患者视力、...     

Corneal perforation associated with silicone oil in the anterior chamber

PURPOSE: To describe the management of three cases of corneal perforation associated with silicone oil in the anterior chamber. METHODS: Review of 3 case records. RESULTS: Three cases of perforation associated with silicone oil in the anterior chamber are reviewed. One patient required gluing and a bandage contact lens, whereas the second patient required an emergency corneal transplantation. The third patient responded to conservative measures, including the use of topical antibiotic ointment. CONCLUSIONS: Corneal perforation associated with silicone oil in the anterior chamber is rare and can be difficult to manage. Potential treatments including the use of cyanoacrylate glue, application of antibiotic ointments, use of aqueous suppressants, and other conservative measures may be effective. In extreme cases, corneal transplantation may be necessary.     

部分板层角膜移植联合层问羊膜移植治疗角膜穿孔

目的 探讨层间羊膜移植联合部分板层角膜移植治疗角膜溃疡穿孔的临床疗效。方法对4例角膜溃疡穿孔患者,行角膜溃疡板层切除、层间羊膜移植联合部分板层角膜移植术。术后利用共焦显微镜和裂隙灯显微镜进行观察,随访1～7个月。结果术后3例裸眼视力得到提高,1例裸眼视力下降,但所有病例的矫正视力都有提高。未见双前房、免疫排斥反应等并发症。结论该手术是一种有效的治疗周边角膜穿孔的方法。     

Application of sodium hyaluronate to the operation of suturing the corneal perforation

AIM: To evaluate the effect of the application of sodium hyaluronate on the operation of suturing the corneal perforation. METHODS: Sodium hyaluronate was used in the operation of suturing the corneal perforation in 76 patients to form the anterior chamber, protect eye tissues and separate the anterior iris synechia. RESULTS: In the procedure of operation, the anterior chamber was stable, the prolapsed iris was easily restored, the corneal wound was easily sutured and there was no damage to the lens. Postoperatively, the corneal wound was closed well, the anterior chamber formed and there was no anterior iris synechia. Fifty-four cases had round pupils and the pupils of 22 cases were not round with defect of iris. CONCLUSION: Sodium hyaluronate in the operation of suturing the corneal perforation can help form the anterior chamber, protect the eye tissues and make the suturing corneal wound easier. It can reduce the rate of complication and promote the wound healing.