绷带式角膜接触镜在板层角膜切除术治疗真菌性角膜溃疡中的应用

目的　探讨板层角膜切除术联合绷带式角膜接触镜及局部和全身应用抗真菌药物治疗真菌性角膜溃疡的效果。方法　收集2015年1月至2017年6月于我院确诊为真菌性角膜溃疡的患者49例49眼，所有患眼均为感染范围在8 mm以内、感染深度小于1/3角膜厚度者，均行板层角膜切除术，根据术后处理方法不同分为两组，观察组29例29眼使用抗真菌药物联合绷带式角膜接触镜治疗，对照组20例20眼仅给予抗真菌药物治疗。观察两组术后角膜上皮愈合时间、眼睑刺激症状消失时间，记录术后1 d、7 d、14 d、1个月、3个月及6个月的裸眼视力（uncorrected visual acuity，UCVA）和最佳矫正视力（best corrected visual acuity，BCVA）。结果　观察组角膜上皮愈合时间为5~13（9.03±2.31）d，对照组为12~33（19.95±5.55）d，两组相比差异有统计学意义（t=-9.504，P=0.040）。术后观察组患者各随访时间点的UCVA均超过术前BCVA，且安全性指数(术后BCVA /术前BCVA)及有效性指数（术后UCVA/术前BCVA）均远远大于1，对照组术后1~14 d因角膜刺激症状安全性指数未计算，但有效性指数均略大于1，其他各时段安全性指数和有效性指数均明显大于1。观察组眼睑刺激症状消失时间为（1.19±0.95）d，对照组为（16.90±5.05）d，两组相比差异有统计学差异（t=-16.424，P<0.001）。术后3个月、6个月角膜瘢痕遗留情况观察组均优于对照组，差异均有统计学意义（均为P＜0.05）。结论　绷带式角膜接触镜在板层角膜切除术治疗真菌性角膜溃疡中可以有效缩短患者角膜上皮愈合时间，提高患者生存质量，术后尽早地改善了患者视力。

The clinical effect of lamellar keratectomy combined with bandage contact lens for the treatment of fungal corneal ulcer

Objective　To explore the improvement of life quality and visual quality of patients with fungal corneal ulcer treated with lamellar keratectomy combined with bandage cornea contact lens and local and systemic antifungal medicine.Methods　Totally 49 eyes were collected from 49 patients who were diagnosed as fungal keratitis in our hospital from January 2015 to June 2017，and patients whose infection range was less than 8mm and the depth of infection was less than 1/3 corneal thickness were selected according to slit lamp measurement and anterior segmental OCT detection,and then they were randomly divided into two groups:observation group and control group.In the observation group,29 eyes were treated with lamellar keratectomy combined with bandage contact lens,and received high frequency eye drops of natamycin after operation.In the control group,20 eyes were treated with lamellar keratectomy and postoperative natamycin eye drops frequently.The time of postoperative corneal epithelial healing and the duration of orbital irritation disappearance were observed.The uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded at postoperative 7 days,14 days,1 month,3 months and 6 months.Results　The time of postoperative corneal epithelial healing in the observation group was 5-13 days,with an average of (9.03±2.31)days,and in the control group was 12-33 days,with an average of (19.95±5.55)days,and the difference was statistically significant （t=-9.504,P=0.040）.Postoperative UCVA of patients in the observation group at each time point was better than that of preoperative BCVA,and the safety index (postoperative BCVA /preoperative BCVA) and efficacy index (postoperative UCVA/preoperative BCVA ) were both greater than 1.In the control group,the safety index of corneal irritation was not calculated from 1 to 14 days after operation because of corneal irritation symptoms,but the efficacy index was slightly greater than 1,and the safety index and efficacy index of other periods were significantly greater than 1.The duration of orbital irritation disappearance of the patients in the observation group was (1.19±0.95)days,and (16.90±5.05)days in the control group,and the difference was statistically significant （t=-16.424,P<0.001）.Residual corneal scar of the observation group was better than that of the control group at 3 and 6 months after operation,and the differences were statistically significant (all P＜0.05).Conclusion　Bandage corneal contact lens with lamellar keratectomy in the treatment of fungal corneal ulcer can shorten the corneal epithelial healing time,and improve the quality of survival as well as visual acuity postoperative as early as possible.