角膜穿孔的个性化治疗及疗效观察

Clinical observation on the individuated treatments of corneal perforation

目的探讨个性化手术方法治疗角膜穿孔的适应证及其疗效。方法对角膜穿孔患者36例（36眼），其中病毒性角膜炎9眼，细菌性角膜炎8眼，真菌性角膜炎6眼，角膜化学伤4眼，暴露性角膜炎3眼，圆锥角膜、Morren角膜溃疡、异物剔除（伴绿脓杆菌感染）术后各2眼，根据角膜穿孔的病因、大小、位置等综合情况，分别选择穿透性角膜移植术、眼前节重建术、板层角膜移植术和羊膜移植术。术后随访时间5—20（平均12．3）个月。观察患者穿孔愈合情况、术后视力、角膜植片透明度及并发症。结果所有病例角膜穿孔完全愈合，眼球得以保留，视力均有不同程度的提高（手术增视率为100％），术后无一例角膜原发病复发。18眼穿透性角膜移植术的植片与植床对合良好，其中12眼角膜移植片透明，4眼半透明，2眼因排斥反应而混浊；9眼板层角膜移植术中，5眼移植片透明，4眼半透明；眼前节重建术者4眼均恢复了眼前段的解剖结构，未出现严重的排斥反应。结论根据角膜穿孔所处的位置、大小及病因等因素，采用个性化的手术治疗方案能够达到治疗原发病、有效封闭穿孔、控制感染、增进视力等较满意的疗效。

Objective To explore the indication and efficacy of different types of surgery for corneal perforation. Methods In our nonrandomized retrospective case series, thirty six cases （36 eyes）with corneal perforation, in which eight bacterial keratitis, six fungal keratitis, four corneal chemical injuries, three exposure keratitis, and keratoconus, Morren corneal ulcer, after foreign body removal of 2, underwent penetrationg kerato- plasty,anterior segment reconstruction, lamellar keratoplasty, amniotic membrane transplantation, according to the cause of corneal perforation, size, location and other comprehensive situation. Postoperative perforation healing, visual acuity, corneal graft clarity and complications were studied during a follow-up of 5 to 20 months. Results All perforation was closed,postoperative visual acuity was improved in 36 cases（ 100% ） in varying degrees,and none of the primary keratopathy recurred. 12 grafts of penetrating keratoplasty were transparent,4 were semi-transparent＇,2 were cloudy because of rejection. 5 grafts of lamellar keratoplasty were transparent,4 were semi-transparent. 4 grafts receiving anterior segment reconstruction restored the anatomy of anterior segment, without serious rejection. Conclusion In patients with corneal perforation, operation should be done according to the cause of corneal perforation, size, location and other comprehensive situation. It is an effective approach for treatment of primary disease, infection control, preservation of eyeballs and restoration of visual function.