急诊使用角巩膜缘联合残留物覆盖大型角膜穿孔1例(英文)

Emergency use of combined remnants of 2 corneo-scleral rims to cover a large corneal perforation: a case report

目的:探讨联合两个经保存的同源角巩膜修补片紧急修复伴有晶状体受挤压和玻璃体暴露的角膜穿孔,在成形性穿透性角膜移植术后的应用。方法:一位49岁的患者患广泛性真菌性角膜溃疡并发后弹力层膨出和微小穿孔。患者在接受了暨成形性穿透性角膜移植术后暴发了自发性大规模角膜穿孔伴晶状体驱逐和玻璃体暴露。鉴于覆盖破损处的迫切需要,供体角膜又无法立即获得,采用联合两个经保存的角巩膜修补片的双移植片。结果:手术成功不仅恢复了眼球的完整性,也免于眼内容物剜除。在接下来的几周内,移植片开始愈合,除了补片的巩膜部分,其它部位有良好的再上皮化,没有感染的迹象,并且能够保持手动视力。鉴于上皮缺损,患者配戴了绷带式角膜接触镜,同时被建议重复穿透性角膜移植术。结论:在缺乏角膜移植片的情况下,可采用一个或多个经保存的同源角巩膜修补片覆盖大范围的角膜缺损。

AIM： To describe the use of a combination of 2 preserved homologous corneoscleral patches for the emergency repair of a perforated cornea with extruded lens and exposed vitreous in a lady who had undergone tectonic penetrating keratoplasty. METHODS： A 49-year-old lady had presented with an extensive fungal corneal ulcer which was complicated by a descemetocele and microperforation. She had undergone a therapeutic cum tectonic penetrating keratoplasty. However, she developed a spontaneous large corneal perforation with expulsion of her crystalline lens with exposed vitreous. In view of the urgent need to cover the defect, a double graft combining 2 preserved full-thickness corneoscleral patches were used as donor cornea was not immediately available. RESULTS： The surgery was successful in not only restoring the integrity of the globe but also saved her of evisceration. Over the next few weeks, the graft began to heal and there was good re-epithelisation except over the scleral part of the patch. There were no signs of infection and she was able to maintain a vision of hand movement. She was put on a bandage contact lens in view of the epithelial defect. She has also been advised about an elective repeat penetrating keratoplasty. CONCLUSION： In the absence of a corneal button for grafting, one or more preserved homologous corneo-scleral patch（es） may be used temporarily for covering large corneal defects.