手术干预联合药物治疗真菌性角膜溃疡疗效观察

The role of lamellar keratectomy in the treatment of fungal corneal ulcer

目的探讨手术干预联合药物治疗真菌性角膜溃疡的临床疗效。方法对40例(40只眼)真菌性角膜溃疡患者在药物治疗同时,适时采用溃疡板层清创、溃疡板层清创联合前房冲洗或结膜瓣遮盖等手术治疗。随访≥3个月,观察治疗效果及预后。结果 40例真菌溃疡患者,仅1例因角膜供体缺乏采取了球内容物剜除术,治疗总有效率97.5%(39/40),除去2例行穿透性角膜移植术治愈患者,有效率仍达92.5%(37/40)。结论在真菌性角膜溃疡药物治疗的同时,适时的采取手术干预及方式是一种行之有效的方法,适用于广大基层医院开展。

Objective To study the outcomes of surgical interventions in the treatment of fungal corneal ulcer,and to look for an optimal strategy that could be widely used among primary ophthalmic care settings. Methods Totally 40 patients（ 40 eyes） with fungal corneal ulcer were enrolled in this study. Besides topical antifungal agents,lamellar keratectomy,or lamellar keratectomy combined with 0. 02% fluconazole anterior chamber wash,or lamellar keratectomy combined with conjunctival flap covering were performed according to disease stages. The outcomes were evaluated during 3-month follow-up period. Results Most of our patients were successfully treated with above surgical interventions. One patient eventually underwent ocular enucleation. Two patients received penetrating keratoplasty and were cured. Overall success rate of lamellar keratectomy was 92. 5%（ 37 /40）. Conclusion Appropriate surgical intervention is necessary to treat fungal corneal ulceration. Relatively simple procedures like lamellar keratectomy could be used even in primary hospitals.