干燥保存角膜在感染性角膜溃疡治疗中的应用

Application of donor corneas by dry preservation in treatment for infective corneal ulcer

目的:评价应用干燥保存角膜片对554例严重感染性角膜溃疡行治疗性角膜移植手术的效果。方法:选自我院角膜病组1976-08/2000-12期间应用干燥保存角膜片对严重感染性角膜溃疡行治疗性角膜移植手术共计554例,本组病例统计分类为真菌性(238例)、单疱病毒性(170例)、细菌性(70例)及混合感染性(76例角膜溃疡4种,分析临床应用效果。结果:本组手术治疗严重感染性角膜溃疡平均有效率88.8%,其中真菌性角膜溃疡81.5%,单疱病毒性角膜溃疡98.2%,细菌性角膜溃疡97.1%,混合感染性角膜溃疡82.9%。结论:无水氯化钙-硅胶干燥长期保存的角膜片为临床随时提供角膜材料,是一项简单易行、便于推广应用的方法;在临床治疗过程中尽快、尽早查明感染病原体,可避免盲目性;对严重感染性角膜溃疡,治疗性角膜移植可直接清除病灶、较快地控制炎症、缩短治疗过程,达到保存眼球及恢复部分有用视力,为下一步光学性角膜移植创造条件。

AIM. To evaluate the clinical effects of therapeutic keratoplasty using donor corneas of dry preservation for 554 cases of severe infective corneal ulcer. METHODS： From August 1976 to December 2000, 554 cases of severe infective corneal ulcer were treated in our hospital with therapeutic keratoplasty using donor corneas by dry preservation. These patients were divided into fungus corneal ulcer group （238 cases）, herpes simplex corneal ulcer group （170 cases）, bacterial corneal ulcer group （70 cases） and mixed infective corneal ulcer group （76 cases ）, clinical effects were analyzed through statistical means. RESULTS： The average effective rate of therapeutic keratoplasty in treatment for severe infective corneal ulcer was 88.8% in this study. The effective rates in the fungus corneal ulcer group, the herpes simplex corneal ulcer group, the bacterial corneal ulcer group and the mixed infective corneal ulcer group were 81.5%, 98.2%, 97.1%, 82.9% respectively. CONCLUSION： 1） The long-time dry preservation of corneas in water-free calcium chloride-silica gel is able to supply corneal materials whenever necessary. Therefore it is an easy, simple and practical method. 2） It is essential to find out the pathogens early and rapidly in order to avoid aimless clinical work. 3） As for the treatment of serious corneal ulcer, therapeutic keratoplasty can clear infective foci, control the process of inflammation, shorten the period of treatment, and keep eyeballs and recover partial useful vision, all of which created conditions for optical corneal transplantation.