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、...

Treatment of corneal perforation with lamellar keratoplasty combined with autogenous corneal stromal padding

Objective To study the clinical outcome of lamellar keratoplasty combined with autogenous corneal stromal padding for treatment of corneal perforation.Methods An observational case series study was conducted.A total of 14 patients(14 eyes)with corneal perforation underwent lamellar keratoplasty in Henan Provincial People's Hospital from January 2017 to August 2018 were collected.During the operation,the corneal stromal autograft was taken to pad the corneal perforation.Visual acuity,intraocular pressure,corneal epithelial healing time,infection recurrence,and the status of corneal graft and anterior chamber were recorded on the 1st,7th,14th day,1st,3rd,6th,9th and 12th month after operation.OCT examination of anterior segment was performed at 1 month,6 and 12 months postoperatively to observe the interlamellar structure of corneal implantation bed and stromal graft,anterior chamber and iris.The safety and effectiveness of the operation were evaluated according to the 1-year follow-up.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital(No.HNEECKY-2019[18]).Written informed consent was obtained from each patient prior to entering the study cohort.Results The healing time of corneal epithelium was 2-4 days after operation,(3.01±0.59)days on average.At one day after surgery,all patients had normal anterior chamber depth without aqueous leak and no double chamber was observed.The corneal grafts attached to the implantation bed well and showed mild to moderate edema.There was no recurrence of corneal infection ulcer two weeks after operation,and the corneal ulcer was healed and anterior chamber was well formed in 14 patients.The corneal graft was transparent,and the anterior segment OCT image showed corneal implant bed and graft were well attached,and the anterior chamber depth was normal three months after operation.The best corrected visual acuity of 9 eyes was more than 0.3 one year after operation,and the vision acuity of the 14 patients improved obviously,and no refractory glaucoma occurred after operation.Conclusions Lamellar keratoplasty combined with autogenous corneal stromal padding is a safe and effective surgical procedure for treating corneal perforation.