不规则移植片板层角膜移植治疗蚕蚀性角膜溃疡

The treatment of Mooren's corneal ulcer using lamellar keratoplasty with irregular shape graft

目的 探讨不规则移植片板层角膜移植联合术后 1%环孢霉素 A滴眼治疗蚕蚀性角膜溃疡的效果及对视力的影响。方法 应用不规则移植片板层角膜移植治疗蚕蚀性角膜溃疡 9例 10只眼。术中根据溃疡侵犯角膜的形态切除病变角膜组织及邻近的球结膜和筋膜组织 ,按照植床的形态制作与之相吻合的板层移植片行板层角膜移植术 ,术后应用 1%环孢霉素 A滴眼 6～ 8个月。结果 术后随访 1～ 5年 ,未见复发病例 ,术后 6个月 ,与术前视力比较 ,大部分病例视力不变或提高。结论 不规则移植片板层角膜移植术联合术后应用 1%环孢霉素 A滴眼治疗蚕蚀性角膜溃疡效果肯定 ,只要植片与植床吻合 ,缝线松紧适宜 ,不会导致明显散光而影响视力。

Objective To evaluate the effects and affection on visual acuity of lamellar keratoplasty with irregular shape graft combining with postoperative administration of 1% cyclosporine A eye drop to treat Nmooren's corneal ulcer.Methods 9 cases (10 eyes) of Mooren's corneal ulcer were treated by using lamellar keartoplasty with irregular shape graft.In the operation,involved cornea and nearby bulbar conjunctiva and tenon's capsule were excised.The corresponding corneal graft which is similar in the shape to removed corneal tissue was produced and sutured to the rim of normal cornea.After operation,1% cyclosprine A eye drop was used for 6-8 months.Results All cases were followed up for 1 to 5 years.No recurring cases was found.At 6 months postoperatively,the visual acuity of most of cases was same as or better than pre-operation.Conclusion The lamellar keratoplasty with irregular shape graft combining with 1% cyclosporine A eye drop is effective and practical for treatment of Mooren's corneal ulcer.If the shape of corneal graft coincides with the excised cornea and tightness of suture is moderate,the vision could not decrease due to high degree of astigmatism.