角膜溃疡清创联合结膜瓣遮盖术治疗感染性角膜溃疡的临床疗效

目的探讨角膜溃疡清创联合结膜瓣遮盖术治疗感染性角膜溃疡的临床疗效。方法回顾性系列病例研究。对2002年5月至2014年6月在青岛眼科医院行角膜溃疡清创联合结膜瓣遮盖术的感染性角膜溃疡患者102例（102眼）的临床资料进行分析。统计感染性质、手术并发症、手术效果及视力（logMAR）变化等资料，采用配对样本秩和检验对数据进行统计分析。结果102例患者中，除2例（2.0%）手术失败改行穿透性角膜移植术（PKP）及1例（1.0%）发生结膜瓣回退拒绝治疗随后失访的患者外，其余99例（97.0%）患者角膜感染均成功控制。89例（87.3%）患者术后随访过程中未见明显异常。13例（12.7%）患者出现异常改变：6例（5.9%）患者发生结膜瓣回退，其中1例合并角膜穿孔改行PKP术，另有1例术后发生结膜瓣回退，患者拒绝二次手术，出院之后失访，其余4例行结膜瓣重缝术后溃疡愈合；4例（3.9%）术后角膜溃疡愈合后随访过程中再次发生角膜溃疡；1例因术后感染加重改行PKP术；1例发生大泡性角膜病变；1例出现结膜瓣下上皮植入性囊肿。感染成功控制的99例患者中，术前裸眼视力（UCVA）为3.90（2.60，4.30），出院时UCVA为4.00（2.60，4.48），差异无统计学意义（Z=-1.77，P>0.05）。72例患者随访资料齐全，随访时间（6.1±5.0）个月；术前UCVA为4.00（2.60，4.40），术后3个月为4.30（3.40，4.70），差异具有统计学意义（Z=-2.74，P<0.01）。结论角膜溃疡清创联合结膜瓣遮盖术是控制感染性角膜溃疡的一种有效手术方式。该手术成功率高，并发症少，有助于挽救患者眼球并保留一定的视力。

Therapeutic effects of corneal ulcer debridement combined with conjunctival flap covering surgery for corneal infection

Objective To study the therapeutic effects of corneal ulcer debridement combined with conjunctival flap covering surgery for corneal infection.Methods In a retrospective case series study,102 patients with infectious corneal ulcers who underwent corneal ulcer debridement and conjunctival flap covering surgery in Qingdao Eye Hospital from May 2002 to June 2014 were reviewed.Pathogens of infection,surgical complications,surgical effects,and the change in visual acuity (logMAR) were analyzed.A rank sum test of paired samples was used for statistical analysis.Results Corneal infections were successfully controlled in 99 of the 102 patients (97.0％).Of the remaining three,two patients needed (2.0％) penetrating keratoplasty (PKP) for surgical failure and one patient (1.0％) developed conjunctival flap withdrawal but refused further treatment and was lost to the follow-up.No obvious abnormalities were seen in 89 cases during the follow-up period.There were abnormalities in the other 13 patients:conjunctival flap withdrawal was observed in six patients,of which one patient underwent PKP for corneal perforation after conjunctival flap resuture surgery,one patient refused a second surgery and was lost to follow-up after being discharged from the hospital,and ulcers healed in the other four patients after conjunctival flap resuture surgery.Corneal ulcer was observed during the follow-up in four patients after the primary corneal ulcer had healed.PKP was performed on two patients for an aggravated ocular situation after the surgery,including a patient with corneal perforation after conjunctival flap resuture surgery.Bullous keratopathy and an epithelial implantation cyst under the conjunctival flap were observed in one patient.In the 99 eyes with surgical success,preoperative uncorrected visual acuity (UCVA) was 3.90 (2.60,4.30) and postoperative UCVA was 4.00 (2.60,4.48).The difference was not statistically significant (Z=-1.77,P＞0.05).Seventy-two patients were followed up regularly for more than 3 months (mean,6.1±5.0 months).Of these,the preoperative UCVA and postoperative UCVA at the final follow-up were 4.0 (2.60,4.40) and 4.3 (3.40,4.70),respectively,and the difference was statistically significant (Z=-2.74,P＜0.01).Conclusion Corneal ulcer debridement combined with conjunctival flap covering is an effective surgery to control corneal infection.The surgery has a high success rate and infrequent complications,and it can help save the eyeball as much as possible and retain reliable postoperative visual acuity.