结膜瓣遮盖术治疗难治性角膜溃疡

目的观察应用结膜瓣遮盖术治疗难治性角膜溃疡的临床疗效。方法回顾分析2003年1月至2006年4月在青岛眼科医院和山东省眼科医院行结膜瓣遮盖术治疗的难冶性角膜溃疡患者30例30眼。其中感染及外伤性角膜溃疡10眼，穿透性角膜移植术后植片溃疡16眼，板层角膜移植术后植片溃疡4眼。30眼中，出现角膜溃疡穿孔9眼。对上述患者行病灶清除＋结膜瓣遮盖术治疗，合并穿孔者术中行双层结膜瓣遮盖或重缝植片，术后针对原发病进一步进行药物治疗。结果27例27眼患者1次手术治愈角膜溃疡。3眼术后结膜瓣回退，再次行结膜瓣遮盖加睑裂缝合术，1眼溃疡修复；1眼结膜瓣再次脱落，改行板层角膜移植术；1眼反复行结膜瓣遮盖术3次，最终角膜植片完全自溶。28眼通过结膜瓣遮盖术达到治愈角膜溃疡，保存眼球的目的。结论对于药物治疗无效的难治性角膜溃疡，结膜瓣遮盖术仍是有效的治疗方法，并可作为应急方法治疗角膜穿孔、控制炎症．从而保存眼球，为进一步行角膜移植术提供条件。眼科新进展2．007；27（3）：204-207]

Conjunctival flap covering surgery in treatment of refractory corneal ulcer

Objective To study the clinical curative effect of conjunctival flap covering surgery in treatment of refractory corneal ulcer.Methods Thirty patients(30 eyes) with refractory corneal ulcer that underwent conjunctival flap covering surgery were retrospective analyzed,including 10 cases with infective and traumatic corneal ulcer,16 cases with graft ulcer after penetrating keratoplasty,4 cases with graft ulcer after lamellar keratoplasty.All the patients were treated with removal of the necrotic corneal tissue combined with conjunctival flap covering surgery.Corneal ulcers with perforation was treated with double-layer conjunctival flaps covering surgery.Results Postoperatively,the corneal ulcer in 27 eyes was healed oncely.The rollback of conjunctival flaps was appeared in 3 cases,in which 1 case was healed after treated again by conjunctival flap covering surgery combined with blepharorrhaphy,1 case underwent lamellar keratoplasty after the conjunctival flap desquamated,1 case was healed after received the conjunctival flap covering surgery thirdly.The corneal ulcer was cured and the eyeballs were saved in 28 eyes by conjunctival flap covering surgery.Conclusion Conjunctival flap covering surgery is effective and practical in treatment of refractory corneal ulcer which have not responded to medical therapy,and also can be taken as the stringent method to treat the perforation of cornea and control the inflammation,provide the further condition for corneal transplantation.