结膜瓣遮盖术治疗难治性角膜溃疡42例

Conjunctival flap covering surgery for refractory corneal ulcer in 42 cases

目的观察应用结膜瓣遮盖术治疗难治性角膜溃疡的临床效果。方法对42例(42眼)药物治疗无效的难治性角膜溃疡患者行病灶清除+结膜瓣遮盖术治疗,合并穿孔者行带Tenon囊的改良结膜瓣遮盖术,术后针对原发病行进一步药物治疗。结果33只角膜溃疡未穿孔眼与7只角膜溃疡穿孔眼均1次手术治愈角膜溃疡,达到了保存眼球的目的。2只角膜溃疡未穿孔眼术后结膜瓣脱落,反复行结膜瓣遮盖术2～3次,但最终角膜溶解,未能保住眼球。结论对于药物治疗无效的难治性角膜溃疡,结膜瓣遮盖术仍是有效的治疗方法,尤其是对角膜穿孔的患者,可以控制炎症,保存眼球,为进一步行角膜移植术创造条件。

Objective To study the clinical curative effects of conjunctival flap covering surgery in treatment of refractory corneal ulcer. Methods Forty-two cases （42 eyes） with refractory corneal ulcer that was not cured with routine medical therapy were treated with removal of the necrotic corneal tissue combined with conjunctival flap covering surgery. Corneal ulcer with perforation was operated with modified conjunctival flap covering surgery with Tenon capsule. Primary diseases were further taken drug treatment postoperatively. Results Corneal ulcer were healed in 33 eyes without perforation,7 eyes with perforation just with operation for 1 time and the eyeballs were saved. The conjunctival flap was ablated in 2 eyes without perforation and treated with con.junctival flap covering surgery for 2 to 3 times, but the cornea dissolved and the eyeballs were not saved finally. Conclusions Conjunctival flap covering surgery is effective and practical in the treatment of refractory corneal ulcer, which can not be cured with routine medical therapy, and especially can be taken to treat patients with perforation of cornea. It can control the inflammation and save the eyeball, providing further conditions for corneal transplantation.