眼球筋膜囊修补联合结膜瓣覆盖治疗角膜溃疡穿孔

Tenon’s capsule and conjunctival flap covering for perforated corneal ulcer

目的:探讨眼球筋膜囊修补联合结膜瓣覆盖治疗角膜溃疡穿孔的治疗效果。方法:对18例18眼不同病因导致的角膜溃疡穿孔,应用自体眼球筋膜囊对角膜穿孔区进行修补,并行结膜瓣覆盖手术治疗。术后观察溃疡愈合情况、外露的角膜情况、术后炎症反应、前房形成情况及并发症如继发青光眼、虹膜粘连等。结果:溃疡愈合17例(94%),成功保住眼球,并且角膜外露部分透明度良好。所有病例术后均未发生严重感染,前房形成。2例(11%)术后继发青光眼,经局部药物治疗眼压控制在正常范围。7例(39%)虹膜粘连,1例(6%)角膜再次穿孔且继发角膜葡萄肿行球内容物剜除术。结论:在供体角膜缺乏时,眼球筋膜囊修补联合结膜瓣覆盖治疗角膜溃疡安全有效,是一种实用的治疗方法。

AIM： To evaluate the efficacy of simultaneous covering of Tenon’s capsule and conjunctival flap for perforated corneal ulcer. METHODS： Totally 18 cases of perforated corneal ulcer from different causes were covered by Tenon’s capsule and conjunctival flap, respectively. After operation, the healing of corneal ulcer, exposed portions of the cornea, postoperative inflammation, anterior chamber formation and complications such as glaucoma, iris adhesion were observed. RESULTS： Seventeen cases（94%） were healed, the exposed portion of cornea was transparent. No serious infection was encountered, and anterior chamber were formed. Intraocular pressure in 2 cases （11%） of secondary glaucoma was normal under local drug treatment. Iris adhesion was found in 7 cases （39%）, evisceration was performed in 1 case （6%） after corneal perforation and staphyloma. CONCLUSION： The above treatment is a safe and practical approach in case of absence of corneal donor.