联合或不联合板层角膜移植的结膜瓣移植治疗巩膜坏死

Conjunctival flap transplantation combined or not combined partial lameHar keratoplasty in the treatment of scleral necrosis

目的介绍结膜瓣移植治疗眼部烧伤和眼科手术后巩膜缺血坏死的手术方法，观察其临床疗效。方法回顾性病例研究。2007年1月至2012年3月，共13例眼部烧伤和眼科手术后巩膜缺血坏死、溶解的患者在山东省眼科医院接受了结膜瓣移植，其中碱烧伤4例．热烧伤6例．翼状胬肉切除手术后巩膜坏死3例。对所有患者行带蒂结膜瓣转位或游离结膜瓣移植术治疗，其中4例行单纯结膜瓣移植，2例联合部分板层角膜移植（LK）术，6例联合羊膜移植（AMT）术，1例联合LK和AMT术。随诊3—24个月，对手术后巩膜坏死和结膜瓣存活等情况进行观察。结果移植的结膜瓣1周内血运差、色苍白，1周后逐渐出现充血表现，2周拆除结膜瓣缝线后充血症状逐渐减轻。13例患者结膜瓣均愈合良好，巩膜坏死控制。至最后一次随访，2例角膜透明，3例角膜植片透明，1例角膜斑翳．7例角膜血管化。结论结膜瓣移植（或联合LK和AMT）治疗眼部烧伤和眼科手术后巩膜坏死在临床上安全有效，能够较好地解决巩膜穿孔的风险，为后续治疗提供一个相对稳定的眼部环境。

Objective To evaluate the clinical efficacy of conjunctival flap transplantation for the treatment of seleral necrosis after eye burns or ocular surgeries. Methods It was a retrospective case series study. A total of 13 cases of scleral necrosis, including 10 patients with eye burns and 3 cases with post-pterygium excision, received conjunctival flap transplants in Shandong Eye Hospital from January 2007 to March 2012. Four patients received conjunctival flap transplants only, 2 patients had combined lamellar keratoplasty （LK）, 6 patients received combined amniotic membrane transplants （AMT）, and 1 patient had combined LK and AMT. The follow-up period ranged from 3 to 24 months after the surgery and during this time scleral necrosis status, conjunctival flap survival, et al, were monitored. Results The transplanted conjunctival flap appeared pale within 1 week after the surgery, and congestion developed after 1 week with conjunctival flap healing. The congestion gradually disappeared when the suture was removed after 2 weeks. The conjunctival flaps healed with the sclera and necrosis was controlled in all patients. At the final follow-up evaluation, corneal transparency was observed in 2 patients, clear graft in 3 patients, corneal macula in 1 patient, and corneal vascularization in 7 patients. Conclusion Conjunctival flap transplantation （or combined LK and/or AMT） is a safe and effective method for the clinical treatment of scleral necrosis. This method can prevent the risk of scleral necrosis and perforation and establishes a stable ocular surface for further treatment.