预控角膜溃疡近穿孔复式遮盖临床分析

The study of prevention and control of corneal ulcer nearly perforating with duplex covering

目的探讨角膜溃疡近穿孔羊膜移植与结膜辨修复（复式遮盖）的可行性，并对其疗效进行评价。方法分析角膜溃疡近穿孔患者33例38只眼，经控制感染后手术清创溃疡面，采用抗体阴性无菌处理后的新鲜羊膜，对深达角膜基质层溃疡底层放置二至三层羊膜，以大于溃疡面2毫米羊膜植片将其上皮层向上移植固定于巩膜表面上，并将邻近角膜溃疡处移转的球结膜瓣加压遮盖于羊膜上且固定。单层羊膜移植组（单式遮盖）是将角膜溃疡单层遮盖作为对照组。结果复式遮盖组的38只眼中角膜溃疡近穿孔者手术一次成功，术后有2只眼（0．53％）结膜瓣回缩暴露下方的移植羊膜，而羊膜无滑脱，再次行球结膜覆盖。有2只眼羊膜自行溶解，无一例穿孔，溃疡均治愈，视力提高0．2以上有15只眼（39．47％）。单式移植组26只眼中羊膜脱落14只眼（53．84％），视力提高0．2以上7只眼（26．92％）。结论羊膜移植能促进角膜溃疡快速修复，减少瘢痕形成，为角膜溃疡缺损区提供理想的基底膜。在其上加固球结膜辨（复式遮盖）可促进局部血液循环并使药物向溃疡处缓慢渗透，达到控制炎症预防角膜穿孔以保存眼球甚至提高视力的目的。

Objective To study the possibility of treating corneal ulcer nearly perforating with amniotic membrane transplantation combined with conjunctive vane repairing and evaluate its efficacy. Methods Thirty-eight eyes of 33 patients with corneal ulcer nearly perforating were investigated in the study. The ulcer surfaces were cleaned through surgery after infection controlled, on the bottom of which two or three layers of fresh, antibody-negative and aseptic processing amniotic membranes were placed, then a piece of amniotic membrane with 2mm larger than the ulcer surface was put on it and fixed with suture. Results The operation of 38 eyes was successful. After the operation, 2 eyes＇ conjunctive valves were exposed to the transplanting cornea, but the amniotic membranes were not off. Self-dissolution occurred in 2 eyes＇ amniotic membranes without perforation. Conclusions Providing basic membranes for ulcer defects, amniotic membrane transplantation may improve the repairing of corneal ulcer in early course and reduce the formation of scar. Duplex covering can help local blood circulation and infiltrate medicine into ulcer in order to control inflammation, prevent corneal perforation, save eyeball and improve vision.