干燥保存角膜片在真菌性角膜溃疡手术治疗中的作用

Evaluation of the results of therapeutic lamellar keratoplasty and penetrating keratoplasty for fungal corneal ulcer

目的 评价干燥保存角膜片在真菌性角膜溃疡手术治疗中的作用。方法 对 5 4例 (5 4只眼 )药物治疗无效的真菌性角膜溃疡患者采用无水甘油或无水氯化钙保存的角膜片 ,分别行板层角膜移植术及穿透性角膜移植术治疗 ,术中分别以 5 %碘酊烧灼植床表面及氟康唑原液或稀释液冲洗前房 ,以观察其治疗效果。结果 板层角膜移植组 2 3例 ,1次手术成功者 18例 ,2次手术成功者 3例 ,手术成功率为 91 3% ;2例术后角膜炎复发 ,改行穿透性角膜移植术后炎症控制。穿透性角膜移植术组 31例 ,1次手术成功者 2 7例 ,4例因角膜炎未能控制或难治性青光眼行眼内容摘出或眼球摘除术。5 4例中 ,5 0例经手术治疗后角膜炎症控制 ,成功率为 92 6 %。结论 采用无水甘油或无水氯化钙保存的角膜片可对药物治疗效果不显或对现有药物耐药的真菌性角膜溃疡者行治疗性角膜移植术 ,可及时去除病灶、控制炎症、保存眼球 ,为再次增视性角膜移植术创造条件。对角膜溃疡病灶较浅者行板层角膜移植术 ,术中注意板层切除的深度 ,并应用 5 %碘酊烧灼植床表面 ;对病灶较深者 ,可视前房炎性反应的轻、重用氟康唑原液或稀释液冲洗前房 ,有助于手术成功率的提高。

Objective To evaluate the effects of therapeutic lamellar and penetrating keratoplasty for fungal corneal ulcer Methods Donor corneas preserved in pure glycerine or water free calcium chloride were used in corneal transplantation for fungal corneal ulcers that were poorly responsive to the anti fungal medical treatment, 5% iodine was used in lamellar keratoplasty to kill the fungi in the recipient bed, and diluted or original solution of fluconazole was used in penetrating keratoplasty to wash the anterior chamber Results In the lamellar keratoplasty group, there were 23 cases; 18 cases were cured with one surgery and 3 cases were cured after second surgery, the success rate being 91 3% There were 2 cases with recurrence of corneal inflammation, and the lesion was controlled by penetrating keratoplasty The penetrating keratoplasty group included 31 cases, of them, 27 cases were cured with one surgery and 4 eyes were enucleated due to recurrent corneal inflammation or refractive glaucoma In the total 54 cases, the inflammation was controlled in 50 cases after therapeutic corneal transplantation, success rate being 92 6% Conclusions For those fungal corneal ulcers that are poorly responsive to anti fungus eye drops, it is recommended to perform lamellar keratoplasty if the ulcer is located in the anterior 1/2 stroma, the key points of surgery are to remove the affected tissue completely and cauterize the recipient bed with 5% iodine For deep ulcers or nearly perforative or perforated ulcers, diluted or original solution of diflucan is used to wash the anterior chamber during penetrating keratoplasty, that can help to improve the success rate