玻璃体切割术后持续性角膜上皮缺损的诊治探讨

Discussion of treatment for persistent corneal epithelium defect after vitrectomy

目的:总结、探讨玻璃体切割术后并发持续性角膜上皮缺损的诊治经验。方法:对玻璃体切割术后并发持续性角膜上皮缺损的10例11眼进行三联或四联治疗,即停止原有术后抗炎眼药水点眼、促进角膜修复眼药水点眼、球周适量激素应用及临时性睑裂缝合术治疗,观察角膜病变修复的情况,并统计持续性角膜上皮缺损的发生率。结果:玻璃体切割术后并发持续性角膜上皮缺损发生率为2.2%(11/509),其中糖尿病性视网膜病变玻璃体切割术后并发持续性角膜上皮缺损发生率为4.8%(8/165),治疗后全部愈合(100%),病程2～6wk,遗留角膜云翳者5眼(45.5%)。结论:玻璃体切割术后并发持续性角膜上皮缺损,是多因素作用的结果,其中糖尿病患者高发值得重视。终止药物毒性作用、加强角膜营养以及必要时的临时性睑裂缝合术是有效的治疗方式。

AIM：To summarize and discuss the treatment experience in persistent corneal epithelium defect after vitrectomy.METHODS： The repairment of cornea by tri- or quad-kinds treatments for 10 cases 11 eyes with the persistent corneal epithelial defect after vitrectomy were evaluated. Original postoperative anti-inflammatory eyedrop was halted, instead of dropping serum eyedrop to promote corneal repair. Moderate hormone was applied by retrobulbar injection and temporary eyelid saturation. The ratio of persistent corneal epithelium defect after vitrectomy was analyzed.RESULTS： The rate of persistent corneal epithelium defect after vitrectomy was 2.2% （11/509）, the rate of diabetic retinopathy case was 4.8% （8/165）. The curative rate was 100%. The rate of corneal nebula was 45.5% （5/11）. CONCLUSION： The reason for persistent corneal epithelium defect is complex. It’s worth paying attention to diabetes cases. To terminate drug toxicity, strengthen the nutrition of cornea and suture the eyelid temporarily are the effective treatments