自体结膜瓣覆盖术治疗深层角膜溃疡

目的：评价自体结膜瓣覆盖术对深层角膜溃疡的治疗效果。

方法：分析于2010-05/2011-10在中国医科大学眼科中心行自体结膜瓣覆盖术的14例深层角膜溃疡患者的预后。14例患者中包括6例病毒性角膜炎患者，7例真菌性角膜炎患者和1例细菌性角膜炎患者。进行结膜瓣遮盖术前，真菌性角膜炎患者用氟康唑冲洗角膜溃疡，细菌和病毒性角膜炎患者用庆大霉素液体冲洗角膜溃疡。根据角膜溃疡大小不同采取部分或全部结膜瓣覆盖术。术后根据不同的角膜炎类型使用不同的抗菌素共4wk。所有的患者术后均随访观察结膜瓣存活情况、并发症及视力恢复情况，随访时间达10～18mo。

结果：所有患者经历1次手术后均痊愈(治愈率为100%)。除1例结膜瓣脱落外，其余患者术后2wk自体结膜瓣均存活并与角膜溃疡处贴附紧密(85.71%)。这13例患者的结膜瓣在随访观察期间内逐渐变得透明并发生了不同程度的退缩。1例真菌性角膜炎患者在术后3mo时角膜炎复发，在使用那他霉素眼液点眼3wk后痊愈。1例患者术后3mo时并发浅前房。1例患者术后10mo并发后弹力层膨出。1例患者术后1a并发了青光眼。所有的患者成功地保留了眼球，但视力提高不明显。

结论：自体结膜瓣覆盖术治疗深层角膜溃疡有效，但是术后长期观察存在一定的并发症。

Autogenous conjunctival flap covering in treatment of deep corneal ulcer

AIM: To evaluate the therapeutic effect of autogenous conjunctival flap covering on deep corneal ulcer.

METHODS: The data of 14 eyes of 14 patients with deep corneal ulcer who underwent autogenous conjunctival flap covering in China Medical University Eye Center from May 2010 to October 2011 were retrospectively analyzed. There were 6 cases of viral keratitis, 7 cases of fungal keratitis, 1 case of bacterial keratitis. Patients of fungal keratitis were rinsed with fluconazole, patients of viral or bacterial were rinsed with gentamycin before conjunctival flap covering. Part or whole conjunctival flap covering were done according to the size of corneal ulcer. Antibiotics were used for 4 weeks according to different keratitis post-operation. All the patients were followed-up 10-18 months postoperation, corneal ulceration repairation, conjunctival flap survival situation, complications and visual acuity were observed.

RESULTS: Corneal ulcer in all cases cured by once surgery(100%).Autogenous conjunctival flap survived and sticked with ulcer closely 2 weeks post-operation(85.71%), except one case conjunctival flap fell off. The another 13 patients conjunctival flaps became transparent and retracted in different degree in the later following-up time. One recurred case of fungal keratitis three months post-operation was cured by dropping natamysin for 3 weeks. One case complicated with shallow anterior chamber three months post-operation. One case complicated with descemetocele ten months postoperation. One case complicated with glaucoma one year postoperation. All the patients preserved the globe, but vision improved unconspicuously.

CONCLUSION: Autogenous conjunctival flap covering is effective for deep corneal ulcer.But long-term postoperative observation has certain complications.