板层角膜移植治疗真菌性角膜溃疡

Lamellar keratoplasty for fungal corneal ulcer

目的探究板层角膜移植治疗真菌性角膜炎的手术时机、适应症、优点和预后.方法通过对真菌性角膜炎的病原学和病理学特点以及板层角膜移植手术方法、手术时机、优点和预后的回顾,讨论了板层角膜移植治疗真菌性角膜炎的优越性.结果板层角膜移植术(Lamellar?keratoplasty,LKP)手术安全性高、并发症少、其成本和对供体的要求较低,能够在早期通过彻底清除病灶阻断真菌进一步向深层角膜浸润.最重要的是,LKP能够保存患者自身的后弹力层和内皮层,一定程度上阻断了角膜移植带来的排斥反应.结论真菌菌丝浸润较快,真菌性角膜感染较其他菌种致角膜感染更严重、前房积脓更多,因此真菌性角膜炎的早诊断和早治疗分外重要.LKP适用于炎症早期局限于角膜基质层内,也就是中浅层角膜的溃疡,相较于传统术式穿透性角膜移植术(Penetrating?keratoplasty,PKP),LKP具有更大的安全性和优越性,现已将LKP做为治疗非穿孔性真菌性角膜溃疡的首选术式.

Objective To explore the timing,indications,advantages and prognosis of lamellar keratoplasty(LKP)for fungal keratitis.Methods Through a review of the etiology and pathology of fungal keratitis,as well as the surgical methods,timing,advantages and prognosis of lamellar keratoplasty,the superiority of lamellar keratoplasty in the treatment of fungal keratitis was discussed.Results LKP surgery has high safety,fewer complications,low cost and low donor requirements,and can block the fungus from further infiltrating the deep cornea by completely removing the lesions in the early stage.The most important thing is that LKP can preserve the patient's own posterior elastic layer and endothelial layer,blocking the rejection caused by corneal transplantation to a certain extent.Conclusion Fungal hyphae infiltrate faster,and fungal corneal infections are more serious than other strains of corneal infections and more anterior chamber empyema.Therefore,early diagnosis and early treatment of fungal keratitis are extremely important.LKP is suitable for ulcers confined to the corneal stromal layer in the early stage of inflammation,that is,the ulcer of the middle and superficial cornea.Compared with traditional PKP,LKP has greater safety and superiority.LKP has become a treatment and the first surgical choice for nonperforated and fungal corneal ulcers now.