结膜瓣遮盖联合虹膜嵌顿术治疗全层感染真菌性角膜炎

目的：观察结膜瓣遮盖联合虹膜嵌顿术治疗全层感染真菌性角膜炎的疗效。 方法：分析2005-03/2011-04在邢台眼科医院行结膜瓣遮盖+虹膜嵌顿术的深部真菌性角膜炎患者26例26眼，全部的病灶的范围均<(5×5)mm²，角膜刮片检查真菌菌丝全部为阳性；前房积脓（+），病灶均较致密，术前不能确定病灶累及深度；在术中，当病灶剖切至接近后弹力层深度时，根据临床特点，对于病灶累及角膜全层，但直径≤1mm的患者，人为在残余病灶的近周边处刺透角膜，造成角膜穿孔，自角膜穿孔或破溃处注吸前房积脓和抛光内皮斑后，将相邻近的虹膜嵌顿在角膜穿孔处，并用缝线固定1～2针，最后行结膜瓣遮盖术，尽量保持水密，术后继续给予抗真菌治疗并密切观察。 结果：患者26例中有5例在病灶剖切中自行破溃，3例在病灶剖切中不慎切透，18例角膜基质床在剖切过程中完整；结膜上皮恢复时间为13.44±2.21d；24例感染得到控制，成功率为92%；2例因感染未控制而改为角膜移植术，最终控制感染。 结论：结膜瓣遮盖联合虹膜嵌顿术是治疗小范围的全层真菌性角膜炎的有效方法，它可以控制感染，为以后的增视手术创造条件，适合在基层医院开展。

Conjunctival flap covering combined with iris incarcerating surgery for the treatment of full-thickness fungal keratitis

AIM: To observe efficacy of conjunctival flap covering combined with iris incarcerating surgery for the treatment of full-thickness fungal keratitis. METHODS:Totally 26 cases(26 eyes) with fungal keratitis which were conducted conjunctival flap covering combined with iris incarcerating surgery from March 2005 to April 2011 in Xingtai Ophthalmology Hospital were analysed. All the range of lesions <5×5mm2, all fungal hyphae were positive in corneal scraping examination: hypopyon (+), lesions relatively dense. The depth of lesions could not be determined before surgery. During surgery, when the lesion was cutted close to descemet, based on clinical features, according to the lesions ≤ 1mm in diameter, artificially pierced the cornea residual disease near surrounding, and resulted in corneal perforation. After aspirated hypopyon and polished smooth endothelial plaque, the nearby iris was incarcerated among the corneal perforation, and fixated by suturing 1 or 2 needles, and conducted conjunctival flap covering surgery at last, tried to maintain water density. Anti-fungal treatment and closed observation should also maintain after surgery. RESULTS:Five of 26 cases self-ruptured during the lesion cutting, 3 cases accidentally cutted through,18 cases of corneal stromal bed were complete in cutting process, recovery time of conjunctival epithelial was 13.44±2.21days. 24 cases of infection were controlled, the success rate was 92%. Due to uncontrolled infection, two cases were performed keratoplasty, and finally the infection was under control. CONCLUSION:Conjunctival flap covering combined with iris incarcerating surgery is effective for the treatment of small-scale and full-thickness fungal keratitis, which could control infection, and create conditions for future improving vision surgery, and suitable for carrying out in the primary hospital.