结膜瓣遮盖术治疗难治性角膜溃疡的临床观察

CONJUNCTIVAL FLAP COVERING SURGERY IN TREATMENT OF REFRACTORY CORNEAL ULCER IN PRIMARY HOSPITAL

目的观察结膜瓣遮盖术治疗难治性角膜溃疡的临床效果。方法对40例(40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,据角膜溃疡的位置以及有无角膜穿孔采用略有不同的手术方式,术后针对原发病行进一步药物治疗。结果 33眼1次手术治愈角膜溃疡;7眼术后结膜瓣回退,再次行结膜瓣遮盖术,5眼溃疡修复,2眼反复行结膜瓣遮盖术3次,最终角膜自溶。溃疡愈合有效率达95%。38眼通过结膜瓣遮盖术达到治愈角膜溃疡,保存眼球的目的。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,尤其是对不能开展角膜移植的基层医院,可以控制炎症,保存眼球,具有重要的临床应用价值。

Objective To study the clinical curative effect of conjunctival flap covering surgery in the treatment of refractory corneal ulcer.Methods Forty patients（40 eyes） with refractory corneal ulcer were treated with the removal of the necrotic corneal tissue combined with conjunctival flap covering surgery.Different types of operation designs were adapted.Corneal ulcers with perforation were treated with double 2 layer conjunctival flaps covering surgery.Results Postoperatively,the corneal ulcer in 33 eyes was healed once and for all.The roll back of conjunctival flaps appeared in 7cases,in which 5 cases were healed after the conjunctival flap covering surgery,and two other cases were healed after receiving the conjunctival flap covering surgery for the third time,and finally autopepsia.The corneal ulcer was cured and the eye balls were saved in 38 eyes by conjunctival flap covering surgery.Conclusion Conjunctival flap covering surgery is effective and practical in the treatment of refractory corneal ulcer which does not respond to medical therapy,and also can be taken as the stringent method to treat the perforation of cornea and the control the inflammation,providing the further condition for corneal transplantation.