角膜结膜病灶切除联合冷凝术治疗蚕蚀性角膜溃疡

Surgical excision of corneal and coniunctival lesions combined with cryotherapy in the treatment of Mooren＇s ulcer

目的探讨手术切除角膜结膜病灶组织联合二氧化碳直冷凝术治疗蚕蚀性角膜溃疡的效果。方法对16例（17眼）通过手术切除溃疡周围球结膜和角膜病灶组织，实施二氧化碳直冷式冷凝，辅以免疫抑制剂等药物治疗，直至角膜溃疡修复、愈合，随访1～5年。结果本组在治疗中，均未发生病情加重或感染情况，有7眼经一次联合治疗治愈，4眼多次冷凝后治愈，4眼出现病情反复，经再次联合治疗后，病情控制未再复发。2眼先后复发，行“角巩膜板层移植”手术治疗。结论手术切除角膜结膜病灶组织联合二氧化碳冷凝治疗蚕蚀性角膜溃疡效果良好。关键是彻底清除溃疡周围病灶组织，冷凝时要掌握适度的温度、时间、次数。

Objective To discuss the efficacy of surgical excision of corneal and conjunctival lesions combined with carbon dioxide cryotherapy for the treatment of Mooren＇s ulcer. Methods 16 cases （ 17 eyes） were underwent surgical excision of corneal lesions and conjunctival tissues adjacent to ulcer, followed with carbon dioxide cryotherapy, immunosuppressive agents were administered until the ulcer healed. All the cases were followed up for 1 to 5 years. Results None of the cases had infection and deterioration during therapy. 7 cses （7 eyes） cured after combined therapy once, cryotherapy 4cases（4eyes） cured after repeat- ed carbon dioxide cryotherapy 4cases （4 eyes） appeared to recurrent attacks, yet no recurrence was detected after repeated combined therapy. 2 eyes appeared to recurrent attacks, and accepted the corneoscleral lamel- lar graft. Conclusion The surgical excision of corneal and conjunctival lesions combined with cryotherapy is effective to treat Mooren＇s ulcer. The key procedure is excising the lesion tissues completely and mastering the appropriate temperature, time and frequency in cryotherapy.