多层羊膜填塞治疗微小角膜溃疡穿孔

目的观察多层羊膜填塞治疗微小角膜溃疡穿孔的临床效果，了解其有效性、安全性和局限性。方法对12例12眼角膜溃疡继发微小穿孔（穿孔直径0．5～3．0mm）患者采用多层羊膜填塞治疗。其中细菌性6例、病毒性2例、真菌性4例。清除溃疡处坏死组织，用多层羊膜填塞穿孔，其表层羊膜间断或连续缝合固定于浅层角膜上，单层羊膜再次覆盖于整个角膜表面，连续或间断缝合固定于角巩缘。术后继续使用药物治疗原发病。随访6—24个月。观察患眼溃疡愈合、前房形成、角膜厚度及并发症等。结果术后第1天，患眼前房均形成，穿孔区密闭良好，炎症控制。术后40—60d，溃疡瘢痕愈合，溃疡表面完全被角膜上皮覆盖，角膜厚度基本正常，视力均有不同程度提高，随访期间前房稳定，未出现溃疡复发及严重并发症。结论羊膜填塞治疗微小角膜溃疡穿孔安全有效。但溃疡以瘢痕愈合。

Multilayer amniotic membrane plugging for the treatment of small corneal perforation associated with ulceration

Objective To investigate the efficacy, safety and limitation of muhilayer amniotic membrane plugging for small corneal perforation associated with ulceration. Methods 12 cases （ 12 eyes） of small corneal perforation secondary to ulceration were treated by amniotic membrane plugging including 6 cases of bacterial keratitis ,2 cases of virus keratitis and 4 cases of fungal keratitis. The size of the perforation was 0.5 - 3.0 mm in diameter. The necrotic tissues were removed and the multilayer amniotic membrane was applied to tamp the per- foration and another big amniotic membrane was covered on the surface of the entire cornea. Postoperative medication was continued to treat the original diseases. All patients were followed up for 6- 24 months and the reformation of the anterior chamber,recovery of the ulcer ,corneal thickness and complications were observed. Results The anterior chamber was reformed at the first day postoperatively and was kept in normal depth in the follow-up time with perforation area being closed tightly. Between postoperative 40 - 60 days ,the ulcer was recovered with scar and the surface of the ulcer was covered with corneal epithelium, whose thickness was normal. The vision of all patients was improved with different degrees. During the follow-up, no case of recurrence or severe complication was noticed. Conclusion Muhilayer amniotic membrane plugging is safe and effective in the treatment of small corneal perforation associated with ulceration, but the ulcer was healed with sear.