4%碘酊“桥状”灼烧治疗近穿孔感染性角膜溃疡

Bridge-shaped searing using 4% iodine in the treatment of near perforation infective corneal ulcer

目的探讨应用碘酊＂桥状＂灼烧治疗近穿孔感染性角膜溃疡的疗效。方法选择感染性角膜溃疡近穿孔患者24例（25只眼）,其中治疗组：13例（14只眼）,男性12例（12只眼）,女性1例（2只眼）,年龄27~68岁,平均（45.3±4.3）岁。将角膜溃疡面修剪清创,4%碘酊烧灼溃疡面边缘,在临近角膜溃疡的结膜充血最明显处（大部分患者在角膜缘10：00~2：00）,用手术圆刀刮除条形角膜上皮（自溃疡边缘至结膜处形成桥状连接面）,术前、术后给予角膜营养剂及敏感抗感染药物。对照组：11例（11只眼）近穿孔角膜溃疡患者,其中男性10例（10只眼）,女性1例（1只眼）,年龄19~50岁,平均（40.2±6.9）岁。除不进行局部＂桥状＂碘酊烧灼外,余治疗与治疗组相同。结果随访1.5~4个月,治疗组：于碘酊桥状灼烧后（3±4.5）d,结膜血管侵入角膜缘,于（7±5.5）d,少量血管翳侵入至角膜溃疡处,至2~4周左右时,大量角膜血管翳侵入角膜溃疡,角膜白斑形成,结膜囊内分泌物明显减少,羞明、畏光、流泪的角膜刺激症状明显减轻,如角膜有缝线,此时可间断拆除。对照组：于（14±3.6）d,少量血管翳侵入至角膜溃疡处,至3~4周左右时,大量角膜血管翳侵入角膜溃疡,结膜、角膜刺激症状减轻。其中2例（2只眼）行板层角膜移植术,1例（1只眼）行结膜覆盖术。结论碘酊桥状灼烧近穿孔的角膜溃疡,操作简单,角膜溃疡感染基本可控制,便于开展,尤其是在角膜材料日益紧缺的情况下,可缩短疗程,保存眼球,为减轻病情发展及下一步复明手术打下基础。

Objective To investigate the treatment of 4% iodine＂bridge-shaped＂searing for near perforation corneal ulcer caused by infection. Methods Twenty four cases（ 25 eyes） of infective corneal ulcer that were near perforation were included in this study. Patients were randomly divided into two groups. Both groups were first treated with corneal ulcer debridement and iodine tincture cautery. In group 1（ 13 cases; 14 eyes）,4% iodine was used to sear ulcer margin where conjunctival congestion were the most obvious（ mostly at the limbus 10： 00 ~ 2： 00）. Corneal epithelium was scrapped and bridge junction was formed from the ulcer edge to conjunctival surface. Corneal nutrients and sensitive antibiotics were administrated. In group 2（ 11 cases; 11 eyes）,all the treatments were the same as in group 1 except for the local bridge-shaped searing with 4% iodine. Results Patients were followed for 1. 5 ~ 4 months. In group 1,conjunctival blood vessels started invading limbal at 3 ± 4. 5 days after iodine burn. A small amount of pannus invaded to corneal ulcer at 7 ± 5. 5 days. At 2 ~ 4 weeks,A large number of corneal pannus invaded corneal ulcer,keratoleukoma formed,and conjunctival sac secretion decreased significantly. Corneal irritation symptoms（ photophobia,phengophobia,tears） reduced significantly. Corneal suture can be removed at this time. In group 2,the healing process was relatively delayed compared to that in group 1. At 14 ± 3. 6 days,a small amount of pannus invaded corneal ulcer. Around 3 ~ 4 weeks,a large number of corneal pannus invaded corneal ulcer,and irritation symptoms were reduced. Two cases（ 2 eyes） received layer corneal transplantation and 1 case（ 1 eye） received conjunctival cover in group 2. Conclusions 4% iodine bridge-shaped searing is a simple operation to control corneal ulcer after infection. Especially,it can shorten the treatment course,save the eye,and lay the foundation to the next step operation.