结膜瓣遮盖术治疗角膜溃疡穿孔临床观察

Clinical Effects of Conjunctival Flap Surgery on Perforated Corneal Ulcers

目的探讨结膜瓣遮盖术治疗角膜溃疡穿孔的疗效。方法选择2005年2月-2010年8月治疗角膜溃疡穿孔患者13例13眼,穿孔在角膜瞳孔区8例8眼,周边区5例5眼,穿孔原因:均为角膜溃疡所致;采用结膜瓣遮盖术治疗;观察角膜溃疡穿孔愈合情况及前房形成情况,随访3～12个月,平均7.5个月。结果随访时间3～12个月,角膜溃疡愈合良好,所有病例前房均形成,治疗眼视力均有不同程度提高,其中角膜周边区穿孔视力恢复均在0.8或以上,角膜中央区穿孔视力恢复在0.02～0.40,形成的角膜白斑0.5～2.0 mm,溃疡区形成斑翳或云翳,无新生血管形成。结论结膜瓣遮盖术治疗角膜溃疡穿孔,在角膜溃疡愈合、前房形成、挽救视力方面效果较好,是简便易行、安全有效的治疗方法。

Objective To evaluate the therapeutic effect of conjunctival flap surgery on perforated corneal ulcers. Methods Thirteen patients （13 eyes） with perforated corneal ulcers were referred between February 2005 and August 2010. The perforation occurred in the areas of pupil in 8 patients （8 eyes）, in the areas of periphery in 5 patients （5 eyes ）. The perforations were caused by corneal ulceration in all cases. The conjunctival flap surgery was performed to cover the perforations. The healing of corneal perforation and the status of anterior chamber were observed. All patients were followed up for 3 - 12 months（ mean 7.5 months）. Results All patients were followed up for 3 - 12 months. All corneas ulcers were healed and normal anterior chamber depth were recovered. The visual acuity of treated eyes was improved. The vision of patients with perforations around cornea was improved to O. 8 or higher, and of patients with perforations of center was improved to 0.02 to O. 40. The 0.5 - 2.0 mm leukomas were formed. The nebula was formed on ulcers areas of cornea. No neovascularization invading into the corneas. Conclusion The con- junctival flap surgery for the perforated corneal ulcers is helpful to the healing of corneal and the forming of anterior chamber; it can also improve the vision of patients. It is a safe, easy-operated and effective method to treat perforated corneal ulcers.