异体巩膜移植联合自体结膜瓣覆盖术治疗无菌性巩膜融解的研究

Research of homologous sclera patch grafting combined with autogenous conjunctival flap covering for sterile scleral melting

目的评价异体巩膜移植联合结膜瓣覆盖术治疗眼科手术后无菌性巩膜融解的临床效果。方法对因眼部手术后发生无菌性巩膜融解10例（10只眼）的临床资料进行回顾性分析。进行巩膜坏死组织涂片，微生物培养，及血清学检查。采用异体巩膜移植联合自体结膜瓣覆盖术，术后局部滴眼。结果术前10只眼巩膜坏死组织的细菌及真菌培养均未见微生物生长，仅1只眼类风湿因子异常高表达，8只眼患有干眼。实施异体巩膜联合自体结膜瓣移植术后，8只眼术后32～50d巩膜坏死区愈合，2只眼于术后40d及48d后发生巩膜植片融解。结论全身胶原血管性疾病及手术刺激等所致的免疫反应可能是眼部手术后产生无菌性巩膜融解的主要原因；异体巩膜移植联合自体结膜瓣移植可控制及修复巩膜融解，有效保留眼球的完整性。

Objective To evaluate the clinical efficacy of homologous sclera patch grafting com- bined with autogenous conjunctival flap covering for sterile scleral mehing after opbthalmologic operation. Methods Ten eyes of 10 patients with sterile scleral melting after ophthalmologic operation who underwent homologous sclera patch grafting combined with autogenous conjunctival flap covering were retrospectively re- viewed. The necrotic scleral tissue was smeared and cultured, and the serological examination was carried out. The 10 eyes were treated with FKS06, rbEGF and artificial tears after the operation. Results Before the operations, no bacteria or fungi were found and there was no evidence of inflammation in the 10 cases. The rheumatoid factor was abnormally high expression in one case. 8 patients presented dry eye. About at d 45, 8 cases of the necrotic sclera has healed after operation. 2 cases of the sclera graft began to melt at d 40 and d 48 after operation because of poor vascularization. Conclusion The immunoreaction caused by sys- temic immunity and operation may be the main causes of sterile scleral melting after the ophthalmologic oper- ation. The homologous sclera patch grafting combined with autogenous conjunctival flap covering is helpful to treat the scleral melting which can preserve the eyeball integrity.