角膜穿孔伤缝线的深浅对伤口愈合影响的观察

Observation on the effect of corneal suture depth for wound healing of corneal perforating injury

目的观察角膜穿孔伤缝合术角膜缝线深度对伤口愈合的影响。方法收集2015年1月至2016年1月角膜穿孔伤连续病例55例（55只眼）的临床资料。患者角膜穿孔伤缝合术后行全景模式下眼前段光学相干断层扫描（AS—OCT）检查，观察分析角膜缝线深度、角膜伤口愈合情况及前房结构等的变化。结果根据术后角膜缝线深度达到角膜厚度分为5组：3／4角膜厚度者22例，2／3角膜厚度者25例，1／2角膜厚度者5例，1／3角膜厚度者2例，1／4角膜厚度者1例。角膜缝线大于2／3角膜厚度者，其角膜伤口对合较好，伤口后无虹膜嵌顿；角膜缝线不超过1／2角膜厚度者，其角膜伤口对合不佳，存在伤口内口裂开、伤口后虹膜嵌顿。结论角膜穿孔伤缝合术缝线深度超过2／3角膜厚度，伤口愈合良好。AS-OCT对角膜穿孔伤缝合术的缝线深度的观察及预后的判断有较好的临床应用价值。

Objective To observe the effect of corneal suture depth on wound healing after corneal perforating suture surgery. Methods The data of 55 eyes of 55 consecutive cases with corneal perforating injury from Jan. 2015 to Jan. 2016 were collected. All cases received corneal perforating suture surgery. They were examined with anterior segment panoramic optical coherence tomography （AS-OCT） under panoramic mode. The corneal suture depth, structural changes of cornea and anterior chamber angle were observed and analyzed after surgery. Results All cases were divided into 5 groups according to depths of corneal suture. The depths compared with cornea thickness （CT） were 3/4 CT in 22 cases; 2/3 CT in 25 cases; 1/2 CT in 5 cases; 1/3 CT in 2 eases and 1/4 CT in 1 case. No wound healed or iris prolapse happened in patients with depth≥2/3CT. Corneal wound dislocation, dehiscence and iris attachment occurred in cases with depth ≤1/2CT. Conclusion The corneal suture depth ≥2/3CT for wound healing of patients with corneal perforating injury is effective. Anterior segment panoramic OCT is of value for evaluating outcomes after corneal penetrating suture, determining prognosis, guiding management decisions and surgical planning.