自体角膜转位移植联合双板层角膜移植治疗角膜穿孔效果评价

The efficaly of rotational autokeratoplasty combined with double-lamellar autokeratoplasty for the treatment of cornea perforation

目的评价自体角膜转位联合双板层角膜移植术治疗角膜穿孔的临床效果。方法对2010年6月至2012年12月因角膜穿孔而实施自体角膜转位联合双板层角膜移植术的8例（8只眼）进行了回顾性分析。其中真菌性角膜溃疡穿孔5只眼，铜绿假单胞菌性角膜溃疡穿孔1只眼，角膜Mooren溃疡穿孔1只眼，圆锥角膜急性穿孔1只眼。结果所有患者眼表形态结构均得到有效的恢复，避免了摘除眼球，5只眼保留了有效视力，其中术后1个月矫正视力：手动3只眼，0．04者2只眼，0．05者1只眼，0．08者1只眼，0．1者1只眼。术后14d内8只眼角膜植片上皮均愈合完整，角膜植片与植床对合好。所有患者术后短期内均无其他并发症。结论自体角膜转位联合双板层角膜移植术治疗角膜穿孔安全有效，在缺少角膜供体材料的情况下，是一种有效挽救眼球的治疗方法。

Objective To evaluate the clinical efficacy of rotational autokeratoplasty combined with double-lamellar autokeratoplasty in the treatment of cornea perforation. Methods Eight patients （8 eyes） with cornea perforation who underwent rotational autokeratoplasty combined with double-lamellar autokerato- plasty from June 2010 to December 2012 were retrospectively reviewed. 8 cases （8 eyes） with cornea perfo- ration included 5 cases of fungal corneal ulcers with perforation, 1 case of pseudomonas ulcer with perfora- tion, 1 case of advanced Mooren＇ s ulcer with perforation, and 1 case of acute perforation of keratoconus. All cases underwent rotational autokeratoplasty combined double-lamellar autokeratoplasty. Results After oper- ation, all patients not only preserved their eyeballs, but also retained the best-corrected visual acuity at 1 month after surgery： hand move in 3 eyes, 0.04 in 2 eyes, 0.05 in 1 eye, 0.08 in 1 eye, 0.1 in 1 eye. In two weeks after operation, the grafts epithelium was integrity in 8 eyes. No other postoperative complications developed in all patients. Conclusion Rotational autokeratoplasty combined with double-lamellar autokera- toplasty is an effective method to save eyeballs under the situation of deficiency of cornea donor in the treat- ment of cornea perforation.