板层角膜移植治疗绿脓杆菌性角膜溃疡的临床价值

目的探讨绿脓杆菌性角膜溃疡的病理机制及安全有效的治疗方法。方法应用板层角膜移植术治疗即将穿孔的绿脓杆菌性角膜溃疡，并对病变组织做病理活检。结果２１例（２１只眼）均获得一次手术便可有效控制角膜炎症、成功恢复角膜外形及保留较好视力的理想效果。组织病理学显示，该病除有严重的炎症坏死性改变外，角膜缘球结膜与巩膜、角膜溃疡周围及溃疡底部均有大量淋巴细胞浸润、角膜胶原变性水肿及新生血管伸入。结论绿脓杆菌性角膜溃疡可能存在炎症反应与变态反应共同参与的病理机制，板层角膜移植术能有效阻断上述机制而获理想临床效果。

Clinical values of pseudomonas corneal ulcer treated by lamellar keratoplasty

Objective The study was designed to explore the pathologycal mechanisms and effective methods of treatment for pseudomonas corneal ulcer.Method The nearly perforating pseudomonas corneal ulcer was treated by lamellar keratoplasty and the corneal bottoms were studied histopathologically.Results 21 cases 21 eyes with pseudomonas corneal ulcers were treated by lamellar keratoplasty,the corneal contour was recovered successfully and a good optical outcome was attianed.The study revealed that in the disease not only there was the corneal violent inflammatory reaction,but also there was a large amount of immune cells in the limbal bulbar conjunctiva,sclera,surroundings and base of corneal ulcer.The corneal collagen was degenerative and neovascular vessels invaded the lesion.Conclusions Possibly,both the inflammatory and immune reactions exist in the pathological mechanisms of the pseudomonas corneal ulcer.The pathological processes can be stopped by lamellar keratoplasty and a better clinical outcome can be attaind.